There are very few medical problems that prevent a mother from breastfeeding her baby. There are some situations where nursing must be temporarily interrupted, but if you maintain your milk supply by pumping, you can almost always resume breastfeeding when the medical problem is resolved.
When not to breastfeed
Breast lumps are common in the lactating breasts, and most are not cancerous. If a physician feels that a mass should be biopsied, this can be done under local anesthesia without weaning the baby. All radioactive materials (taken orally or intravenously) and chemotherapeutic drugs cross into the milk and are potentially toxic to the infant. In some cases, mothers are able to discontinue breastfeeding until the drugs are out of their systems, and then resume nursing again. If a nursing mother is diagnosed with any type of cancer, she needs to discuss her feelings about nursing and her treatment options with her obstetrician, pediatrician and oncologist.
HIV and AIDS
These conditions include hypothyroidism, pituitary dysfunction, untreated tuberculosis, excessive postpartum bleeding, hepatitis B and C, active herpes lesions and many types of surgery. Maternal medical conditions that normally do not necessitate interrupting or discontinuing breastfeeding include anemia, diabetes, hyperthyroidism, pituitary tumors (prolactinomas), cystic fybrosis, anemia, asthma, postpartum depression, multiple sclerosis, arthritis, epilepsy, asthma, heart disease, hypertension (high blood pressure) and hepatitis A.
There are several breast problems that may affect a mother's ability to breastfeed. These include congenital lack of glandular breast tissue and breast surgery, including biopsies, breast augmentation and breast reduction. A very small percentage of women are born without enough glandular tissue in their breasts to produce a full milk supply for their babies. Often, one breast will look very different from the other, and the mother reports never experiencing normal breast enlargement during pregnancy. These mothers can still breastfeed, but will need to offer supplements with a bottle or feeding tube.
Medical problems in the infant can also cause problems with nursing, but these conditions rarely contraindicate breastfeeding. On the contrary, infants who are ill need the many nutritional and immunological benefits of breastfeeding even more than healthy infants, except in rare cases.
Babies with some disorders can breastfeed
Transient (temporary) lactose intolerance occurs when a baby suffers from prolonged diarrhea (this is much less common in breastfed than in formula-fed babies, but it can occur). This type of "nuisance diarrhea," caused by intestinal illness, antibiotic treatment, excessive consumption of fruit juice or sensitivity to solid foods, can cause the lining of the baby's intestines to become irritated. It usually clears up within two to four weeks. The best treatment for this condition is to continue breastfeeding. Human milk is a natural fluid that is quickly and easily digested, and is the best food to give babies with diarrhea. In cases of transient lactose intolerance, time -- not weaning -- is the best solution.
Medical conditions that may cause difficulties with breastfeeding include cleft lip and/or palate, Down syndrome, neural tube defects (such as spina bifida), hydrocephalus, hypoglycemia, jaundice, congenital heart defects, reflux, cystic fybrosis, hypothyroidism, celiac disease and allergies. (A special note about allergies: infants are not "allergic" to their mother's milk, but on rare occasions, they may be allergic to a food the mother has ingested -- most often, the offending food is cow's milk, and eliminating it from the mother's diet eliminates the problem).
In all these situations, breastfeeding is not only possible, but is recommended. Careful monitoring of milk intake, adjustment of medications, corrective surgery and supplemental feedings may be required, but breastfeeding these infants offers many important health benefits, as well as increased bonding and closeness.
The mother who is unable to breastfeed or who has to wean prematurely experiences the loss of something very important to her, and often goes through the same stages of grief as the person who is coping with the loss of a loved one: denial (Of course I can breastfeed!...), anger (Why me?), bargaining (If I could just nurse this baby, I'll never ask for anything again...) depression (It makes me so sad to see other mothers nursing their babies) and finally, acceptance (I know that this is not something I can control, and I did everything I could...lots of babies do fine on formula...). It is helpful to be aware of these normal stages, and try to work through each one. It is important that you work with your health care team to explore all the options that might make breastfeeding possible, such as the use of breast pumps, tube feeding devices and delivery of supplemental feedings (whether expressed milk, donor milk from a milk bank or infant formula). Make sure that all these options are fully explained to you.
Sometimes even mothers who are strongly committed and follow all suggestions or instructions to the letter are still unable to breastfeed. In these cases, you need to try to feel good about the fact that you try to provide the best for your child, while making every effort to accept the reality of the situation and the fact that sometimes factors beyond anyone's control make breastfeeding impossible no matter how highly motivated you are or how hard you tried. Once you have reached the acceptance stage, it is easier to place your breastfeeding experience in context, and move on to focus on dealing with the other important aspects of your health and your baby's.