9 Reasons You May Not Be Able to Breastfeed

Doctor William C Lloyd Healthgrades Medical Reviewer
Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Jennifer L.W. Fink, RN, BSN on August 11, 2021
  • Mother bottle feeding infant
    Breastfeeding isn’t best for all families.
    Breastfeeding is great for many moms and babies, but it’s not the best choice for all families. In fact, there are some very good reasons not to breastfeed. If you or your baby have certain health issues, breastfeeding is not recommended. Other medical conditions may make breastfeeding particularly challenging—and in some cases, breastfeeding may be more trouble than it’s worth. Learn more about breastfeeding and HIV, as well as breastfeeding while on long-term medication, including antidepressants, so you can make an informed decision about how to feed your baby.
  • Unseen Caucasian woman holding up red HIV/AIDS ribbon
    1. You have HIV (human immunodeficiency virus).
    If you are infected with human immunodeficiency virus (HIV) and live in the United States or another industrialized nation, you should not breastfeed because your baby could contract the virus by ingesting your breast milk—and because safe alternative feeding options, including formula, are widely available. Antiretroviral therapy (medication to decrease the amount of HIV in your blood) reduces but does not eliminate the risk of HIV transmission. In developing countries that lack easy access to clean water and formula, breastfeeding may still be the best option for HIV+ mothers and their babies.
  • Newborn baby feeding from bottle
    2. Your baby has galactosemia.
    Babies who have classic galactosemia (galactose 1-phosphate uridyltransferase deficiency), a rare genetic condition, absolutely should not breastfeed. Children with galactosemia are unable to digest the sugar in milk— any kind of milk, including human breast milk. All infants born in the United States are tested for this disorder soon after birth, as part of the routine newborn screening. If your child has galactosemia, you’ll need to feed your baby a special non-milk-based formula.
  • Close-up of a woman coughing
    3. You have active tuberculosis.
    Tuberculosis (TB) is a serious lung infection that is spread through the air via exhaled droplets. It is highly contagious, so healthcare experts recommend that mothers with active TB do not breastfeed their infants because a mother could unintentionally infect her infant by coughing, sneezing or breathing on him. However, moms with infectious TB can pump or express their breast milk and have someone else feed it to the baby via a bottle. If the mom’s infection is under control and she is no longer contagious (usually after a minimum of two weeks of antibiotic treatment), the mother can safely breastfeed.
  • hand of scientist holding vial of blood
    4. You have human T-cell lymphotropic virus (HTLV-1/2).
    HTLV-1/2, also called acute T-cell leukemia or acute T-cell lymphoma, is a rare disease that can cause nerve damage. It is most common in the Caribbean, southern Japan, equatorial Africa, South America, and the islands of the southwestern Pacific, including New Guinea and Tonga. Only 0.25 to 2% of the 10 to 20 million people who are infected will develop a progressive neurologic disease, but the disease is devastating enough that affected moms may choose to feed formula rather than chance transmission via breast milk. Approximately 15 to 25% of cases of HTLV-1/2 are the result of breastfeeding.
  • Close-up of woman's hand taking prescription medication pills
    5. You’re taking antidepressant medication.
    Moms who take antidepressant medication may worry about the effect of these drugs on their infants, but the evidence to date suggests that infant exposure to antidepressants via breast milk is low. Furthermore, additional studies have shown that maternal depression can negatively affect babies’ development, so in many cases, it may be safer and healthier for both mom and baby if mom continues antidepressant treatment. If you take an antidepressant, let your doctor know that you plan to breastfeed so you can discuss the possible risks and weigh them with the benefits.
  • Hispanic woman reading medication
    6. You’re on other long-term prescription medications.
    All mothers who take prescription medication on a regular basis should talk to their doctor before beginning breastfeeding. Most medications are safe to continue while nursing, but some are not, so it’s essential to seek the guidance of a qualified healthcare professional. The American Academy of Pediatrics does not recommend breastfeeding if the mother is taking amphetamines (including some common ADHD medications), chemotherapy (cancer treatment), ergotamines (which are often used to treat migraines), and statins (commonly used to treat high cholesterol).
  • Doctor examining bandaged woman
    7. You’ve had previous breast surgery.
    If you’ve ever had a breast reduction, breast enhancement, mastectomy, or other breast surgery, your ability to breastfeed may be compromised. However, many women who have had breast surgery are able to produce breast milk. Some women will be able to exclusively nurse their babies. Other women won’t make enough milk to meet their babies’ nutritional needs and will need to supplement with donated breast milk or formula. Women who have had breast surgery and want to breastfeed should consultant a lactation consultant as soon as possible and work closely with the consultant after birth.
  • African American mother holding young baby drinking from bottle
    8. Your baby has a metabolic disorder.
    After birth, babies are routinely tested for a variety of metabolic disorders that affect how the body digests certain substances. Babies with phenylketonuria (PKU), for instance, can’t efficiently process amino acids and could develop brain damage if regularly exposed a particular amino acid. The good news is, metabolic disorders can be controlled with diet. Babies with PKU can breastfeed, but not exclusively; you’ll need to supplement with formula as well. If your child has a metabolic disorder called G6PD, you can breastfeed, but you’ll need to avoid some foods and medications.
  • Caucasian mother with infant holding her head with headache, fatigue or postpartum depression
    9. You’re experiencing postpartum depression.
    Approximately 1 in 7 women develops postpartum depression after birth. Because postpartum depression can affect a woman’s ability to care for herself and her baby, treatment is essential. Counseling can help. So can antidepressant medication. If you want to breastfeed your baby, your healthcare provider can prescribe an antidepressant known to be safe for nursing infants. If breastfeeding is in any way contributing to your depression, anxiety or overwhelm, it’s OK to switch to formula. Your mental health is far more important to your child’s overall well-being than the way he’s fed.
9 Reasons You May Not Be Able to Breastfeed
  1. Breastfeeding and the Use of Human Milk. American Academy of Pediatrics. https://pediatrics.aappublications.org/content/129/3/e827.full#content-block
  2. Situations Where Breastfeeding is Contraindicated or Not Advisable. New York State Department of Health. https://www.health.ny.gov/diseases/aids/providers/testing/perinatal/docs/breastfeeding_policy.pdf
  3. HTLV Type I and Type II. National Organization for Rare Disorders. https://rarediseases.org/rare-diseases/htlv-type-i-and-type-ii/
  4. Oystein Berle, J., & Spigset, O. (2011). Antidepressant Use During Breastfeeding. Current Women's Health Reviews, 7(1), 28-34. doi:10.2174/157340411794474784. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267169/
  5. Breastfeeding & Medications: What’s Safe? Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/breastfeeding-and-medications/art-20043975
  6. Prescription Medication Use. Centers for Disease Control and Prevention. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/prescription-medication-use.html
  7. Breastfeeding after Breast or Nipple Surgery. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/15585-breastfeeding-after-breast-or-nipple-surgery
  8. Keeping Breastmilk Safe and Health. March of Dimes. https://www.marchofdimes.org/baby/keeping-breast-milk-safe-and-healthy.aspx
  9. Postpartum Depression & Breastfeeding. American Academy of Pediatrics. https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Postpartum-Depression-Breastfeeding.aspx
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Last Review Date: 2021 Aug 11
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