It's true that some women are unable to breastfeed, at least not exclusively. Some women will produce a low supply of breast milk, for example, and others will encounter other issues that make nursing difficult. If you hope to breastfeed, you can still give nursing a try, but be prepared to supplement with infant formula as needed.
There are other reasons why you might be unable to breastfeed, and, rarely, circumstances when it is not advisable to breastfeed. Here's an overview to help you make the best decision about breastfeeding for you and your baby.
When breastfeeding may not be recommended
HIV infection
You should not breastfeed if you have been infected with the human immunodeficiency virus (HIV) and are not on any medication, because the virus can be passed to your child through the milk.
But for moms on an antiretroviral therapy (ART) who have a sustained, undetectable HIV viral load during pregnancy, the risk of transmission of the virus through breast milk is less than 1 percent, so it should be relatively safe for them to breastfeed. Talk to your doctor to see what's advised in your case.
Other infectious diseases
Women infected with cytomegalovirus and hepatitis C generally can breastfeed, but not if their nipples are cracked or bloody. If you have any kind of infectious disease, discuss the risks and options for breastfeeding with your doctor before deciding what to do.
You should not nurse if you have a serious infection like active, untreated tuberculosis.
Undergoing radiation therapy
You shouldn't nurse if you are receiving radiation in any form, and you may not be able to for a period of time before radiation treatment, or after being near a person who is receiving radiation treatment.
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Radiation can be a serious health risk to your baby, so be sure to discuss it with your doctor if you or anyone you know is getting radiation treatment.
Taking medications that pass into breast milk
A report by the American Academy of Pediatrics (AAP) finds that most medications and immunizations are safe to use during lactation, but don't make the decision to nurse while taking medication without discussing it with your doctor.
There are some medications that do pass into the breast milk and can hurt the baby, like chemotherapeutic agents and some mood-altering drugs. Check with your practitioner to see whether any drugs you are taking present a problem, and don't forget to mention supplements, vitamins, herbal teas and remedies, and over-the-counter medications too.
Drug or alcohol addiction
You shouldn't nurse if you have a drug or alcohol addiction and are still using drugs or alcohol.
Smoking
Smokers can breastfeed, but you should maximize the time between smoking and nursing to reduce the amount of nicotine in your milk. Once an hour-and-a-half has passed, the nicotine level decreases by about half.
Never smoke around your baby. A much better plan: Quit smoking and keep breastfeeding your baby.
Medical reasons why breastfeeding may be difficult
Serious illness
While it's okay to breastfeed with some conditions, if you have a serious illness — heart failure, for example, or kidney disease — breastfeeding might not be healthy for you or baby. It's a good idea to discuss any health conditions you have or are at risk for with your doctor before making the decision to breastfeed.
Hypoplasia or IGT
Hypoplasia of the breast, also known as insufficient glandular tissue or IGT, occurs when the mammary tissue and glands don't develop normally. Women with this rare condition often have breasts that don't produce enough milk to nurse exclusively.
Breast reduction surgery
If you've had breast reduction surgery, chances are high that you'll have a low supply of breast milk and won't be able to nurse exclusively because the breast tissue that was removed contained milk glands and ducts. (If you've had breast augmentation, there's also a small chance that you'll have a low supply of breast milk.)
Postpartum depression or anxiety
While you will be physically able to breastfeed with postpartum depression or anxiety, you may find that nursing is an added stressor. Don't feel guilty or distressed if you have to stop.
If you are coping with any psychological condition, discuss the risks of breastfeeding with your doctor. If you and your physician decide that antidepressants would help you feel your best, there are many available that will not harm your breastfeeding baby. Restoring your mental health should be you and your family's top priority.
Feeding baby when breastfeeding is not possible
Pumping supplemented with formula
Whether you're having trouble producing enough milk or need a break from trying, pumping and supplementing with formula can be a solid option. A good breast pump will allow you to build up a stash of milk, and it can help you maintain your supply during periods when your baby is formula-feeding.
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