Recently I saw a mom with Hep B.  She was told the 
conventional wisdom, breastfed (baby got immunoglobins) 
but avoid bleeding nipples.  By the time I saw her at 2 
weeks she had sore nipples from pumping with a flange 
that was too small.  She ordered a new flange and then 
contacted my colleague when she started to have blood in 
her milk a few days later.  At that point we called Ruth 
Lawrence's center to get recommendations both for going 
forward and for using the pumped milk she had stored 
previously, before she could see blood in it.  Mom was 
totally freaked and had no desire to go back to 
breastfeeding after all this.  My question is in parts of 
the world where Hep B is very common, what advice are 
mothers given?  Avoiding nipple damage is of course 
important for every mom but we know that it's something 
we see daily, so what do these moms do?

Karen Kurtz, IBCLC
New Jersey, USA

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