Is It Safe To Breastfeed If...?

If you are a breastfeeding mother, this is a question you will ask yourself a million times. There is a risk-benefit calculation to every choice we make, but when the decision impacts what we feed our baby, a seemingly simple question like, ‘can I take a Tylenol?’ takes on a whole new significance. (And yes, you can by the way.) We asked Dr. Kelsey Kossl, a board-certified obstetrician and gynecologist in New York City, to shed light on what’s safe, what’s not, and what we just don’t know yet.

Is it safe to breastfeed if...
What the doctor says
Additional comments or resources/quotes
have a cold?
Yes
Cold and flu viruses do not pass through breast milk. In fact, if you have the flu, your breast milk contains antibodies that protect your baby from catching the same bug. It is important to cover your mouth and nose when you cough or sneeze, wash your hands frequently, and disinfect surfaces to prevent spreading the illness.
take nonprescription
sleep aids?
Yes
Most over-the-counter sleep aids, including Benadryl and Unisom, are safe for breastfeeding mothers. But it’s wise to minimize how much you take since small amounts pass into the breast milk—excessive or prolonged use could cause infant drowsiness. Alternatives, like exercise and good sleep hygiene, might actually be more effective and are definitely safe. While minimal use of melatonin is probably safe, there is limited data.
take prescription sleeping aids? Ask your doctor If you take any prescription medication, it is important to consult with your doctor before you breastfeed. Certain prescription sleep medication, such as Ambien, pass through breast milk but data indicate it’s in low levels.
take medication for anxiety or depression?
Ask your doctor
It is important to consider the mother’s mental health, safety data, and benefits of breastfeeding. The SSRI class of antidepressants (such as Zoloft) has been the most well-researched and studies show those drugs pass through breastmilk in low dosages and complications from infant exposure are rare.
take birth control? Yes All birth control methods are safe while breastfeeding, but anything containing estrogen (oral contraception, the patch, and the ring) is not recommended during the first weeks of breastfeeding because there is a small risk it can reduce your mild supply.
drink coffee?
Yes
Limit your caffeine intake to about 200mg a day (the amount in two espressos or one cup of drip coffee/cold brew). Newborns and preterm infants may be more sensitive to the effects of caffeine.
drink alcohol?  That depends.

Limit your caffeine intake to about 200mg a day (the amount in two espressos or one cup of drip coffee/cold brew). Newborns and preterm infants may be more sensitive to the effects of caffeine.

get a seasonal flu shot? Yes In fact, the antibodies that you develop will be shared with your baby through your breastmilk.
get the COVID-19 vaccine? Yes Recent studies have shown infants born to vaccinated mothers also had antibodies to Covid and that the antibodies were present in breastmilk. Of course, experts are still learning how Covid and the antibodies against it work, data suggests that vaccinated mothers may be passing their protection to their babies.
use CBD (not THC)? No

There is not enough research or data currently to know.

eat fish? Yes In general, fish is safe but avoid or limit your intake of fish that is especially high in heavy metals and mercury, such as tuna shark, swordfish, king mackerel, and tilefish.
eat processed food? Yes It’s important to maintain a healthy, well-balanced diet that’s rich in vegetables (especially leafy greens), lean protein, and healthy fats (from nuts and avocadoes) for myriad reasons: everything from your energy levels to helping the baby’s neurological system develop properly. Highly processed foods, which tend to be high in sodium and sugar, are not healthy, but there is no data to suggest that in small or moderate amounts they will cause damage to the baby.
get a Botox injection? No No data exist on the use of cosmetic Botox during breastfeeding. While the risk is presumed to be low it is unknown.
use retinol? No Oral retinols (used to treat severe acne) has been shown to cause severe birth defects when used during pregnancy. While topical retinol creams likely have low absorption into a mother’s bloodstream, there are not enough data about its effects in breast milk.
exercise? Yes Moderate exercise is not only safe, it is highly recommended.
get a tattoo? No The risk of infection potentially being introduced via the needle is small, but it’s not zero. It is safer to wait until you are no longer breastfeeding.
dye my hair? Yes In general, anything that is safe during pregnancy is safe during breastfeeding.
smoke marijuana? No Studies have shown that THC in the bloodstream passed into breastmilk. Further, any drug that will impair your judgement is dangerous to a newborn.
go the dentist?
Yes
Local anesthesia is safe.
continue to breastfeed if I am pregnant again? Yes Generally breastfeeding while pregnant is safe. Let your doctor know if you plan to continue breastfeeding during pregnancy—he or she may advise weaning if you are in a high-risk group.
have flat or inverted nipples Yes Talk to your doctor or midwife during your pregnancy or shortly after birth if you have flat or inverted nipples. A consultation with a lactation specialist may be helpful.
am in remission breast cancer or have been treated for breast cancer Talk to your doctor There is no evidence that breastfeeding after breast cancer treatment increases the rate of recurrence. Talk to your doctor to go over some important points. For example. treatments such as surgery and radiation may make breastfeeding more difficult due to reduced milk production, pain, or difficulty latching. (Lactation experts can help.) If you are taking medications to treat or prevent recurrence of breast cancer, talk to your doctor—some medications are not safe for breastfeeding. And be sure to schedule surveillance breast imaging while pregnant and breastfeeding.
have implants Yes Some women who have had prior breast surgery including reduction and augmentation have higher rates of reduced milk supply or engorgement. Talk to your doctor about the signs of engorgement, how to manage it, and how to optimize milk supply.
have pierced nipples No Breastfeeding with nipple piercing jewelry in place is dangerous—it can interfere with latching and is a choking risk. Jewelry should be removed for the duration of breastfeeding. If you are experiencing any breastfeeding issue with nipple that has been pierced in the past, talk to your doctor.
am a smoker Yes Breastfeeding still has benefits over bottle feeding, but women should quit smoking because it places infants at higher risk for respiratory issues and sudden infant death syndrome (SIDS). If you smoke, smoke as far away from your infant as possible and avoid smoking prior to breastfeeding. Nicotine smoking cessation aids, like gum or patches, reduce smoke exposure but still contain nicotine and should be spaced far from when you breastfeed.
had a C-section Yes It is absolutely safe to breastfeed after a cesarean delivery. Ask for assistance with early skin-to-skin contact and finding a comfortable position to breastfeed in. Talk to your provider about a multi-modal approach for pain management while recovering from a cesarean delivery—this will decrease the amount of opioid pain medication used, but it is important to note that good pain control is the goal as this will improve breast-feeding success.
am fasting No We generally recommend avoiding fasting while pregnant or breastfeeding due to the energy demands. If it is important to you, talk to your doctor about safe strategies.