Dear Lactnetters,
Its been a few months since I last posted (but I have been lurking)so I will
reintroduce myself.  I am a RN working in a Special CAre Nursery, have
recently completed all 10 modules of the online BreastEd course and am
planning to sit the IBCLC exam in July.

This week I attended a Hepatitis C conference sponsored by the state health
department and put together by one of the local universities.  Generally the
presentations were excellent and the info. the latest available.  However I
had difficulty when they discussed breastfeeding.  Generally speaking they
said the benefits outweighed the risks and that it was not contraindicated
unless the mother had cracked or bleeding nipples.  When I questioned this
information I was told this was the advise from the college of
Hepatologists.  That although there was not any evidence that there ever
have been any cases of transmission from cracked or bleeding nipples it was
a theoretical risk and they were advising against it.  This information is
also written in the published manual they handed out at the conference
"National Hepatitis C Resource Manual" published by the Australian Institute
for Primary CAre.  I spoke privately to the Hepatologist who  presented
after the presentation and questioned that if there was no evidence of any
baby being infected from cracked or bleeding nipples wasn't it far safer to
advise continued breastfeeding rather that risk the breastfeeding
relationship and all the ensued hazards of formula feeding with the known
documented risks including the risks of gastro, septicaemia, NEC, reduced IQ
etc.  I believe it is a matter of balancing a theoretical and unproven risk
again a documented and proven risk of giving formula and putting the long
term breastfeeding relationship at risk.

These presentations will occur on a regular basis state wide over the next
few months and I am concerned the info regarding breastfeeding may not be
correct.  The hepatologist concerned is prepared to read any research or
policy articles on the topic I send to him.  I have pulled the American
Academy of Pediatrics "Hepatitis C Virus Infection" which makes no specific
mention of cracked nipples and states "Acquisition of HCV infection from
human milk has not been documented.  The overall rate of maternal-infant HCV
transmission among breastfed infants has been the same as that among
bottle-fed infants."  I have done a medline search and come up a blank on
the question of cracked nipples and Hepatitis C.

First of all I am interested in other Lactnetters opinions on this issue and
also in obtaining specific research on this topic.  Also in relation to the
integrity of the gut mucosa what damage is likely to occur from giving
formula (micro-haemorrages etc)?  And is this damage likely to make the baby
more at risk of Hep C transmission once BF is  resumed especially if the
nipples subsequently become cracked again and small amounts of blood are
mixed with breastmilk?  Of course the ideal is to have perfect latch from
the beginning so nipple trauma does not occur but this is not a perfect
world and from time to time this situation does arise with Hep C mothers.  I
have always advised them to keep breastfeeding while working on perfecting
the latch.
TIA for your responses
Marian Rigney (RN)



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