1

Section 6.5: Breastfeeding Education for Pregnant Women 4/2021 References: 246.11(3)(1) Policy: The Local Agency must provide all pregnant women the opportunity to discuss breastfeeding, unless breastfeeding is medically contraindicated. Purpose: To enable pregnant women to make an informed decision about feeding their infant and to overcome any perceived barriers to breastfeeding. Procedures ▪ If the participant has not asked about breastfeeding, the CPA should begin a discussion, providing an opportunity for the participant to express her questions and concerns. ▪ If there are known reasons that breastfeeding is contraindicated, the CPA must document the reason breastfeeding was not discussed. ▪ If there is a concern that breastfeeding may be contraindicated, encourage the participant to discuss breastfeeding with her health care provider, so that the risk/benefit can be assessed. Information on potential contraindications to breastfeeding is listed below. Guidance Breastfeeding Counseling There are several ways to begin a discussion about breastfeeding. CPAs are encouraged to find a method that works best for the participant and the CPA’s counseling style. ▪ Training on breastfeeding counseling is offered regularly. The state can suggest proven/reputable breastfeeding counseling techniques and training opportunities. ▪ The “three – step” counseling method is recommended.

S E C T I O N 6 . 5 : B R E A S T F E E D I N G E D U C A T I O N F O R P R E G N A N T W O M E N 2 ▪ This uses open–ended questions, such as: “What have you heard about breastfeeding?” or “What are your thoughts about breastfeeding?” ▪ Training on the 3-step counseling method is offered when requested. To request training, contact the State WIC Breastfeeding Coordinator. ▪ Simply asking if the participant intends to breastfeed is not an effective counseling strategy. Breastfeeding Contraindications There are few true contraindications to breastfeeding and very few contraindications that will be apparent during pregnancy. The information that follows is for guidance only. Knowledge about breastfeeding is rapidly changing, resulting in changes to recommendations. Use this information as a starting point to seek additional information. Maternal conditions in which breastfeeding is contraindicated ▪ HIV positive or has AIDS. ▪ Human T-Cell Leukemia virus Type I (HILV-1). ▪ Medications such as antineoplastic agents, therapeutic radiopharmaceuticals, and lithium. Other medications may be contraindicated; however, there is usually an acceptable alternative to the medication. Advise participantsto discuss medications with their health care provider. ▪ Unusually heavy exposure to environmental contaminants. Contraindicated only if maternal levels are high. Maternal conditions in which breastfeeding is contraindicated until the condition resolves or is treated ▪ Herpes simplex virus (HSV) on the breast itself ▪ Current use of street drugs or abuse of prescription medications. ▪ Other diseases when infant contact with the mother is not recommended for either breast or bottle-feeding, such as varicella herpes (chicken pox) or active untreated tuberculosis, until it is permissible for the mother to be in contact with the infant. Resources for information about potential contraindications to breastfeeding. ▪ The Transfer of Drugs and Therapeutics into Human Breast Milk: An Update on Selected Topics)AAP Committee on Drugs. Pediatrics 132(3). September 2013. Reaffirmed May 2018. ▪ Medications and Mothers Milk, 19th edition, 2021 Thomas Hale. Springer Publishing. ▪ Infant Risk Center Texas Tech University Health Sciences Center. Staff answer questions from professionals about medication use while breastfeeding or during pregnancy. 8 am – 5 pm CST weekdays. ▪ Drugs and Lactation Database (LactMed®)

S E C T I O N 6 . 5 : B R E A S T F E E D I N G E D U C A T I O N F O R P R E G N A N T W O M E N 3 ▪ Drugs in Pregnancy and Lactation 11th edition, 2017. Gerald Briggs, et al. Lippincott (12th edition to be released April 2021) ▪ Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants Centers for Disease Control and Prevention, 2019. Reference – Complete Listing of Hyperlinks The Transfer of Drugs and Therapeutics into Human Breast Milk: An Update on Selected Topics (https://pediatrics.aappublications.org/content/132/3/e796) Infant Risk Center (https://www.infantrisk.com/) Drugs and Lactation Database (LactMed®) (https://www.ncbi.nlm.nih.gov/books/NBK501922/?report=classic) Contraindications to Breastfeeding or Feeding Expressed Breast Milk to Infants (https://www.cdc.gov/breastfeeding-special-circumstances/hcp/contraindications/index.html) Minnesota Department of Health - WIC Program 625 Robert St N, PO BOX 64975, ST PAUL MN 55164-0975; 1-800-657-3942, health.wic@state.mn.us, www.health.state.mn.us. To obtain this information in a different format, call: 1-800-657-3942 This institution is an equal opportunity provider.