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Newborn and Infant Care

breas feeding



Hi, I was the one who wrote about "breast milk and formula"the reason I cannot breast feed is that I'm hepa B carrier, although the pediatrician said that I can breast feed because the baby was vaccinated within 6 hours of birth and is going to take his hepa shots on time, But i still have doubts, I've read a lot about hepa and breast feeding and the answers are positive,what do you think? and also, why is pumped breast milk second best, what is the difference between pumped breast milk and direct breast milk?


Hello. I am glad you wrote back. Your pediatrician is correct. Research indicates that breastfeeding does not increase the risk that a baby will contract Hep B when a mother is Hep B positive. The choice to breastfeed still is yours.

Possible infant exposure to Hep B during labor or birth via contact with a mother's blood, the amniotic fluid, or vaginal secretions is associated with infant infection with hepatitis B. Whether your baby is breast or bottle-fed, treatment for possible labor and birth exposure is the same. The recommendation is that he should receive hepatitis B immunogloulin (HBIG) within 12 hours of birth, followed by the Hep B vaccine (HBV) series of injections--the first injection within the first week, the second at a month, and the third injection at six months. He should also be screened for HBsAg during his first year to determine if he is a carrier. It will be very important for you to make sure your baby receives the HBV injections at the recommended times; without timely treatment he is much more likely to develop active hepatitis and become a chronic carrier.

Now for your other breastfeeding question: Pumped breastmilk is more likely to be used when a baby is unable to breastfeed for a short or long time, such as when a baby is premature or for a baby with a severe cleft palate. Occasionally, a mother's physical or mental health condition interferes with breastfeeding so she may pump instead of breastfeeding directly.

Direct breastfeeding is best because the milk is not exposed to anything in the environment. Pumped breastmilk is second best because its exposure to cold and then heat may alter its contents very slightly; however, it still is superior to infant formula. In your situation, it is not necessary to pump your milk; there appears to be no health reason for you not to breastfeed directly if you so choose.

Your pediatrician has probably written references regarding breastfeeding when positive for Hepatitis B. You should feel free to ask for them. The references I used for this reply are:

Riordan, J & Auerbach, K (1998). Breastfeeding and human lactation (2nd ed.). Boston, MA: Jones & Bartlett.

Lawrence, RA (1997). A review of the medical benefits and contraindications to breastfeeding in the United States (Maternal and Child Technical Bulletin). Arlington, VA: National Center for Education in Maternal and Child Health.

Again, the best of luck as you begin the wonderful adventure of motherhood. Your baby is lucky that you are so concerned for his health.

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Response by:

Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati