Breastfeeding During Maternal or Child Hospitalization

Patient Guideline Summary

Publication Date: September 16, 2021

Last Updated: November 22, 2023

Objective

This patient summary means to discuss key recommendations from the Academy of Breastfeeding Medicine for breastfeeding during maternal or child hospitalization. The purpose of this guideline is to provide new evidence-based recommendations on the topic.

Overview

Lactating mothers or breastfed infants or children may require hospitalization for medical or surgical reasons. This can disrupt breastfeeding and cause unintended weaning or complications such as mastitis.
Breastfeeding provides extensive health benefits and reducing or stopping it risks increased infections and chronic diseases in children, and type 2 diabetes, cardiovascular disease, and breast and ovarian cancer in women.
Nearly universal breastfeeding could prevent over 800,000 child deaths annually.
Your hospital will empower you to achieve successful feeding of your baby through support from a trained, collaborative care team.

Recommendations

A policy to support the lactating mother and breastfeeding child:

The hospital or medical facility admitting women of child-bearing age or children less than 2 years of age ideally has a policy to support breastfeeding mothers and babies. This policy would:
- allow you to be with your breastfeeding baby as much as possible, unless medically unable.
- state where your baby can be and who can care for your baby if you are the patient.
- choose what type of hospital room you and your baby should have, such as a private room if available.
- talk about safe sleeping equipment the hospital will provide for your baby, such as a bassinet.
- discuss transferring you and your baby to a nearby hospital that can provide the care you need If the hospital does not routinely care for mothers after birth or babies in the hospital.
- include quickly getting you to the same facility If you and your baby both need to be hospitalized but are at different hospitals.
- provide for your basic needs such as food, hygiene, and a place to stay If your baby is hospitalized but you are not.
- provide access to breastfeeding support.
- include plans for expressing and storing your milk, if needed, and getting you equipment and expert help.
If you have surgery planned, your care team should communicate your breastfeeding plan to the surgery team. They should document when you last breastfed or pumped milk, and when you need to next, as part of shift changes or care team changes. This should be communicated to you if your baby is the patient.

Keeping breastfeeding mothers and infants together:

Breastfeeding mothers and babies need to be allowed unlimited time together if hospitalized and here is why:
- Your baby's nutrition comes from you, and your milk provides important benefits when your baby is sick, hurt, or needs medical care. Breastfeeding helps keep your baby calm in an unfamiliar setting.
- It is especially important for you to be together if your baby is very young, to help establish breastfeeding.
- Being together allows you to directly breastfeed on demand, share immune protection, prevent breast engorgement (when a woman's breasts become overly full of milk) or infection, and prevent distress for both of you. It helps you maintain your milk supply, your natural sleep/wake cycles together, and, ideally, exclusive breastfeeding (not supplemented by formula).
- If you and your baby are in different hospitals, you should be moved to the same hospital and share a room if possible. The hospital should accommodate your basic needs such as food so you can focus on your baby.

Evidence-based guidelines for milk expression and storage:

It is recommended to try to breastfeed directly as much as possible, rather than pumping or hand-expressing milk (manually ejecting breast milk). Breastfeeding directly may be easier if you are weak or sick. Pumping takes more effort to set up and clean. Some women do not respond as well to pumps.
Frequency: for babies under 6 months, this is usually 8-12 times per day. A 6- to 12-month-old infant may nurse 5 to 6 times daily, and a 12-month-old infant may nurse only 3 to 4 times daily.
Type of breast pump: A hospital-grade double electric pump is best for separating mothers and babies. You can use your own pump if you prefer. Parts should be cleaned properly. Pumps made for one user should not be shared. Massaging your breasts while pumping may help express more milk. If no pump is available, hand expression can work but is less efficient. A hand pump should also be available as a backup.
Relaxation, warmth, massage, images of your baby, and other comfort measures may help release milk. Reducing stress and distractions is also important. Expressed milk can safely sit at room temperature (20–22°C, 68–72°F) for up to 4 hours before refrigerating. Milk should be labeled with the date and your information and refrigerated promptly once it arrives where it needs to go. Speak with your provider about specific storage guidelines.

Support care for the child of the lactating mother:

If you are hospitalized but wish to keep breastfeeding, you may need someone to care for your baby at your bedside when you cannot. Hospital staff are not responsible for caring for your breastfeeding baby. The hospital should allow unrestricted visits by a caregiver for your baby.

Necessary equipment:

The hospital should provide necessary equipment such as a double electric breast pump, bassinet or crib, and a safe sleep environment. Your baby should not sleep in car seats or strollers.
The hospital should have what is typically available in maternity or baby units locally.
You may bring your own feeding supplies if you are able.
An infant scale may help ensure your baby is gaining weight properly.

Evidence-based safety recommendations for medications, including radiological diagnostic agents:

Most medications are safe while breastfeeding.
Your healthcare provider will consider risks versus benefits for you and your baby. Alternatives will be explored if appropriate.
Medical staff should use reliable resources to check medication safety. Examples are LactMed, the Infant Risk Center, and e-lactancia.
Contrast agents for medical imaging are generally safe.
Radioactive agents generally require stopping breastfeeding temporarily.
Non-radioactive alternatives should be considered when possible.
You should be reassured that each medication you receive has been checked for safety.

Fluid needs:

If you are exclusively breastfeeding a 6-month-old, you may produce around 800 ml (27oz) of milk per day on average, ranging from 450 to 1200 ml (15-40 oz). Your fluid needs are higher to account for this. If you cannot drink, this amount should be added to your total fluids. If you can drink, you should drink to satisfy your thirst.

Infant locations:

Your baby can stay in your hospital room with you, unless you have an infection your baby could catch.
A private room allows more space and calm.
Your baby can also be in the perioperative area (surgery waiting area), unlike other visitors. This allows you to stay together.
In the intensive care unit (ICU), more issues such as equipment and infection control make having your baby present more difficult. But your baby's presence may help calm you, stabilize your vitals, and motivate your recovery. Breastfeeding releases oxytocin which may benefit you therapeutically. Ongoing separation can increase your anxiety. Even if not fully conscious, you may respond positively to your baby's touch, smell, and sounds.
With precautions, many ICUs can accommodate your baby for some visits, such as when you are stable. Skin-to-skin contact and breastfeeding under supervision may be possible. Discuss options with your medical team, focusing on your and your baby's health and emotional well-being.

Infection control and prevention:

Being separated means your baby misses out on antibodies in your milk tailor-made for pathogens you both encounter. And you miss making protective milk components in response to your baby's infections. So, separation should be rare.
Breastfeeding is not recommended with untreated brucellosis, Ebola virus, or active herpes simplex lesions on your breasts.
For HIV, guidelines depend on your circumstances.
Many common infections do not require stopping breastfeeding, just precautions such as hand hygiene.
With most infections, you can provide pumped milk even if direct breastfeeding is not advised, with some expectations. Discuss any infections with your medical team.
If you have a contagious respiratory illness such as COVID-19, a support person may need to care for your baby while you recover. Hospital staff should minimize handling your baby unless clinically necessary. Focus on your health while continuing breastfeeding or pumping with proper hygiene precautions.

Lactation support for the surgical adult patient:

For planned surgeries, your care team should address maintaining breastfeeding as part of your care plan. This includes:
- identifying you as breastfeeding before surgery.
- attention to feeding/pumping in the preoperative area.
- careful fluid management and pain control in surgery.
- reuniting you and your baby for breastfeeding when you recover.
Anesthesia clears from milk as it clears your brain, so you can resume nursing when awake and alert. Anesthesia choices should be breastfeeding-friendly.
For major surgeries requiring an ICU stay, your surgeon should coordinate a full lactation support plan with your care team.
In emergencies such as trauma surgery, trauma surgeons know the precautions and differences for breastfeeding mothers.

The unconscious lactating mother immediately postpartum:

If you are unable to communicate after giving birth, your wishes still matter. Your health proxy should make decisions as you would want.
Immediate milk removal from your breasts is key to establishing breastfeeding later.
Even if sedated or unconscious, you may benefit from your baby's presence through improved vitals and motivation. With coordination, visits, and skin contact may be possible.
If unable to express milk yourself, ensure experienced staff assist with pumping, using proper technique and equipment to avoid nipple damage.

Admitting the lactating mother to inpatient psychiatry:

If you require psychiatric hospitalization while breastfeeding, your care team will support continuing lactation if you wish.
Having a policy for psychiatric units is key to maintaining lactation. Mother-baby units allow infants to stay and optimize bonding and breastfeeding.
Aim for safe visitation and contact with your baby during hospitalization. Supervised visits may be needed to ensure appropriate interaction. Expressing milk with pumps and proper storage is encouraged when direct breastfeeding isn't possible.
Staff should assist if you are unable to express milk yourself.
Your proxy can guide decisions if you are unable.
Psychotropic medications require balancing risks and benefits. Many are safe, but combinations may require caution. Your regimen should be evaluated individually and for your child. Your psychiatric health is the priority.

Breastfeeding for hospitalized infants and children:

If your breastfed baby or child is hospitalized, unlimited access to you is important.
Your basic needs should be met at the hospital.
Your stress due to a hospitalized infant can affect the milk supply. So, do not hesitate to ask for help.
Express milk with a double electric pump as often as your child would normally feed. This maintains the supply and provides milk. Support may be needed if volumes seem low. Skin contact can help breastfeeding resume. Resources are available for breastfeeding children with chronic conditions.
If your hospitalized child has a breastfed sibling, allow that sibling to stay with you unless unsafe. Provide a safe sleep space. Get lactation support if separation is unavoidable.
In the pediatric intensive care unit (PICU), encourage pumping from the start, even in the emergency room. Coordinate pumping support if your child is transferred.
Mechanical ventilation can cause feeding difficulty, especially under age 2. Skilled help transitioning back to breast is key. Even on oxygen support, direct breastfeeding can better regulate milk flow and calm infants.
Infants with congenital conditions especially benefit from breast milk but may face challenges. Prenatal education and ongoing skilled support are crucial. Direct breastfeeding can stabilize infants when possible.
After surgery, facilitate breastfeeding resumption as soon as possible. Multidisciplinary support helps navigate tubes, lines and pain control.
Weighing before and after breastfeeding can aid fluid management for critically ill infants while supporting breastfeeding.

Source Citation

Bartick M, Hernández-Aguilar MT, Wight N, Mitchell KB, Simon L, Hanley L, Meltzer-Brody S, Lawrence RM. ABM Clinical Protocol #35: Supporting Breastfeeding During Maternal or Child Hospitalization. Breastfeed Med. 2021 Sep;16(9):664-674. doi: 10.1089/bfm.2021.29190.mba. Epub 2021 Sep 6. Erratum in: Breastfeed Med. 2021 Nov;16(11):928. PMID: 34516777.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.