PSA: The CDC on swine flu and breastfeeding

A lot of people think that breastfeeding is a tenuous, fragile, and even dangerous thing. Oh, they might concede that breastfeeding is a fine thing to do if it’s easy, and the mother is perfectly healthy, and the baby is perfectly healthy, and the planets align.

But should anything be slightly out of kilter, “Stop breastfeeding!” is the immediate cry. People who are better informed have a word for this: “sacrificing breastfeeding on the altar of ignorance”. Baby small? Supplement! Baby big? You’ll never have enough milk! Baby is born with a disability? There is no way you’ll be able to breastfeed! Baby has gastroenteritis? Stop the milk, feed electrolyte solution! Mother ill? Formula time! Mother needs antibiotics or antidepressants? Wean! Mother needs surgery? Wean NOW! Mother has a glass of wine or a mammogram or an immunisation or a CT scan? Pump and dump! (Many of these myths are debunked in Jack Newman’s excellent handouts, collected at the superb resource Kellymom.)

So: what would you think would be the best course of action in the event of a flu pandemic? Stop breastfeeding? Isolate sick mothers from babies, lest they infect them through their dirty, dirty milk? Stick babies safely in an isolette? Feed them “clean”, “scientific”, “safe” cow’s milk formula?

You’d be wrong.

The answer is clear: breastfeed, and wash your hands. Health News Digest has information from the CDC and the United States Breastfeeding Committee (emphases are mine):

The Centers for Disease Control and Prevention (CDC) issued updated guidance today on H1N1 (swine) flu considerations for pregnancy and breastfeeding, stating that: “Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness. Women who deliver should be encouraged to initiate breastfeeding early and feed frequently.” […]

USBC Chair Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC, affirms the importance of breastfeeding in emergency situations: “Research clearly shows that breastfeeding provides a safe, reliable food source, full of disease-fighting cells and antibodies that help protect infants from germs and illnesses. Mothers exposed to influenza produce specific protection for their infants and transmit this through their breast milk. Infant formula does not provide these specific infection fighting properties. Unnecessary formula supplementation should be eliminated so the infant can receive as much benefit as possible from maternal protective antibodies and other immune protective factors.”

Women can continue to breastfeed while receiving antiviral medications. CDC guidance recommends that if a woman is ill, she should continue breastfeeding and increase feeding frequency.

If the mother or infant is too ill to breastfeed directly at the breast, the mother should be encouraged to pump and feed her breast milk to her infant. In certain situations, infants may be able to use donor human milk from a milk bank certified by the Human Milk Banking Association of North America.

The CDC reports that although the risk of H1N1 (swine) flu transmission through breast milk is unknown, reports of seasonal flu being transmitted through breast milk are rare. In addition, by the time a mother begins showing symptoms of the flu, her infant has already been exposed. The mother’s milk can provide additional protection for the infant from complications of the flu, such as severe respiratory symptoms, diarrhea, other gastrointestinal infections, and dehydration.

A lot of people shrug off WHO information on infant feeding as “oh, that’s only for third world countries”. Apart from the fact that women and children in “third world countries” matter (hello?), the aftermath of Hurricane Katrina showed us that even in relatively small-area emergencies in industrialised countries, babies’ health can be compromised by breastmilk-substitute feeding. It is not breastfeeding that is fragile and easily disrupted; it’s formula feeding.

When water is unsafe for infants, when food supplies are interrupted or unreliable, when feeding implements cannot be properly cleaned, when there are viral and bacterial infections spreading rapidly: the risk of artificial feeding, already there in the best of conditions, skyrockets. It is much easier to feed mothers safely than it is to supply formula to babies – and feeding mothers saves two lives, not possibly-maybe-one. A high level of community breastfeeding support* means that in disasters, not only do the breastfed babies do much better, but the few babies who cannot be fed by their mothers will have ample donor breastmilk or cross-nursing available.

Further reference: CDC: “Pregnant Women and Swine Influenza Considerations for Clinicians

See also: The World Health Organisation’s booklet on Infant Feeding in Emergencies.

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* and I am talking societal support here, not pointing the fingers at mothers who are generally doing the best they can in difficult situations.

This type of discussion has a tendency to derail into “nasty do-gooders want to ban formula and make mums feel guilty”. Here’s my take: some women choose to use breastmilk substitutes. A few women are unable to produce enough milk to feed their child despite support and information and treatment, for various reasons, and choose breastmilk substitutes in the absence of donor milk or in preference to it. Many, many women are poorly supported, poorly informed, have limited opportunities to avoid forced separations from their baby, and end up using breastmilk substitutes even if it wasn’t their original choice. None of these things happens in a vacuum.

This post is not about individual women and how they should or shouldn’t feel as individuals. It is about systems that fail women and children, by failing to support breastfeeding, by sacrificing breastfeeding on the altar of ignorance, by “primitivising” breastfeeding in derogatory terms (misogyny and racism! Whee!), by blaming women’s “defective” bodies for any and all problems, by forcing separation from a very young age, by encouraging nuclear family formations in which new mothers are overworked and isolated, and by not having donor milk available for the women who need it. It is about the larger corporate, medical, and societal structures that encourage and market the normalisation of massively high rates of artificial feeding in certain countries.

Please also understand that my breastfeeding advocacy is not about legal rights. A feminist can critique patriarchal influences on motherhood without saying that formula should be banned or woman should be forced to breastfeed.



Categories: gender & feminism, health, medicine, Science

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3 replies

  1. Thanks for the information. I had a CT scan with IV contrast six months back. I wasn’t (and am not) a nursing mother, but I was very angry to see on the routine information sheet that breastmilk produced in the next 48 (I think) hours was not to be fed to a baby. I wasn’t asked about having children or otherwise warned in advance. What would an actual nursing mother have been able to do without warning to build up a stored supply?
    It is even more outrageous now that I have learned that that advice is overly cautious.
    Also a generally interesting post. I would have assumed already that it was safe and desirable to feed a baby through illness but it is good to have that much information.

  2. I would have assumed already that it was safe and desirable to feed a baby through illness but it is good to have that much information.

    It _seems_ like common sense to me, but it’s clear from lots and lots of the public chatter and questions about breastfeeding that common sense has gone way, way out the window!
    On the other hand, I can see why some people think they should isolate themselves from a baby while they have flu (real flu) – but it just isn’t supported by the actual science.

  3. I think that’s really cool. The first ones to come up with a ‘flu vaccine will in effect be breastfeeding Mums!
    Deus Ex Macintosh’s last blog post..That Pig Wont Fly: swine flu special

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