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Situations that affect breastfeeding

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HealthWiki > A Book for Midwives > Chapter 16: Breastfeeding > Situations that affect breastfeeding


Twins should be breastfed just like other babies. Remember, the more a mother breastfeeds, the more milk her body will make. A mother can breastfeed both babies at the same time or she can breastfeed them one at a time.

A mother with twins will need more rest, food, drink, and help from her family and from you.

2 breastfeeding babies lying on pillows at the mother's side.
Two good
positions for
2 breastfeeding babies lying on pillows in the mother's lap.

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Small babies and early babies

Most small babies and early babies need breast milk. If the baby is too weak to suck from the breast, a mother can remove her milk by hand and then feed her baby with a cup or spoon until the baby is strong enough to breastfeed. Learn more about caring for small babies.

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Breastfeeding while pregnant

It is safe to breastfeed while pregnant or to breastfeed an older child and a new baby. The mother should eat even more food and get plenty of rest.

The new baby should always be fed before the older baby.

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When the mother is sick

It is usually best for a mother to keep breastfeeding even when she is sick. To prevent becoming more sick, the mother can:

  • drink plenty of fluids.
  • lie down while breastfeeding.

Family members and friends can help the mother with her chores so she can rest.


If possible, breastfeeding mothers should not take drugs or medicines. But some mothers who are sick must take medicines. These women should use medicines that are safe to take while breastfeeding.

the word WARNING! above a drawing of a breastfeeding woman.
This medicine is not safe to take while breastfeeding.

Most of the medicines listed in this book are safe to take while breastfeeding. A few that are not safe are marked with this symbol in the green medicine pages.


Mothers who are breastfeeding should protect themselves from becoming infected with HIV.

Some mothers with HIV pass the infection to their babies through breast milk. Other mothers with HIV breastfeed their babies and their babies do not become infected. No one knows exactly why HIV is passed to some babies and not others. HIV probably passes more easily during breastfeeding when:

  • the mother recently became infected with HIV.
  • the mother is very sick with AIDS.
  • the mother gives formula or other fluids or foods along with breast milk.
  • the mother has cracked nipples or a breast infection.
  • the baby has thrush in her mouth.
a health worker speaking to a pregnant woman outside a tent.
You have a very difficult choice to make.

For most mothers, even mothers with HIV, breastfeeding is the safest way to feed their babies. That is because in most places, formula and other milks cause many babies to get sick or die from diarrhea or hunger. Many more babies die from taking formula than get sick or die from HIV passed through breastfeeding.

If a mother with HIV chooses to breastfeed, here are some things that may make it safer:
  • Give only breast milk for the first 6 months.
    Babies who have breast milk and formula, teas, or other foods or drinks are more likely to become infected than babies who drink only breast milk. Any other foods or liquids will irritate the baby's intestines.
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To prevent cracked nipples, help the baby get a good mouthful of breast.
  • Stop breastfeeding completely after 6 months.
  • Position the baby correctly to avoid cracked nipples.
  • Treat thrush, cracked nipples, and breast infections right away.
  • Do not feed the baby from a breast that has mastitis or an abscess — instead, remove the milk and throw it away.

A woman who is being treated with medicines for HIV is less likely to pass the disease while breastfeeding.

Heating breastmilk to prevent passing HIV
Breast milk can be heated almost to boiling to kill the HIV virus. A baby will not be at risk of getting HIV from this heated milk. Heating breast milk takes work, but it can be done if a woman has clean water, fuel, and support.

How to heat breast milk

1. Place a jar of breast milk in a pot of water. Breast milk should not be boiled.
2. Bring the water to a boil.
3. Immediately remove the pot from the heat. Heated milk should be used within a few hours.
4. Let the milk cool before feeding it to the baby with a cup or bottle.

This page was updated:11 Sep 2019