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Breastfeeding and lactation problems
Almost every woman can keep breastfeeding — with mastitis, fever, most medicines and a contrast CT; the true contraindications are few and worth knowing by name.
Why it matters in the exam
The exam asks "what is an absolute contraindication to breastfeeding?", whether a breastfeeding mother having a contrast CT must stop, how mastitis is treated, and which contraception suits the lactation period. Other questions deal with antidepressants during breastfeeding.
The common mistake is advising to stop breastfeeding "to be on the safe side" — unnecessary stopping harms infant and mother, and in mastitis it even makes things worse.
The family doctor follows mother and infant together, so he is the one who spots early breastfeeding difficulty, postpartum depression or infant weight loss, and connects the mother with a lactation consultant. Early support in the first weeks is the most important factor in continuing breastfeeding. A recurring question: a breastfeeding mother who needs a contrast CT — she keeps breastfeeding.
Key points
- Most drugs and tests do not require stopping breastfeeding.
- Contraindications: galactosaemia in the infant, HIV, HTLV, illicit drugs, chemotherapy, radioactive iodine.
- Mastitis — keep breastfeeding; antibiotics if no improvement within 12–24 hours.
- Contraception during breastfeeding — progestogen-only or a device.
- Depression — sertraline, keep breastfeeding.
Summary table
| Situation | What to do | Exam note | Source of the mistake |
|---|---|---|---|
| Absolute contraindications | Classic galactosaemia in the infant, maternal HIV (where water and formula are safe), HTLV, drugs such as cocaine, chemotherapy or radioactive iodine | Untreated active tuberculosis — temporary separation, expressed milk is possible | — |
| CT with iodinated contrast or MRI with gadolinium | Continue breastfeeding; no need to stop | A negligible amount reaches the infant | Stopping "for 24 hours" is not required |
| Mastitis | Keep breastfeeding and emptying, NSAIDs; if no improvement within 12–24 hours — cephalexin or dicloxacillin for 10–14 days | A lump with fever that does not improve — ultrasound for an abscess | Stopping breastfeeding makes it worse |
| Maternal hepatitis B or C | Continue breastfeeding (hepatitis B — after vaccine and immunoglobulin for the infant) | In hepatitis C pause only when nipples are cracked and bleeding | — |
| Postpartum depression | Sertraline or paroxetine suit breastfeeding | — | Do not stop breastfeeding in order to treat |
| Contraception | Progestogen-only or an intrauterine device | Combined oestrogen methods — avoid in the first 6 weeks | Exclusive breastfeeding with amenorrhoea up to 6 months protects about 98% |
In the full version for subscribers
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Sources
- Academy of Breastfeeding Medicine, 2022 — Clinical protocol #36: the mastitis spectrum
- American Academy of Pediatrics, 2022 — Policy statement: breastfeeding and the use of human milk
- American College of Radiology Manual on Contrast Media, 2024 — Administration of contrast media to women who are breast-feeding
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.