Breastfeeding is recommended for at least the first 4-6 months of life by all major medical organizations yet rates remain low. Delayed initiation and interruption of breastfeeding are both identified barriers to breastfeeding success. We hypothesized that in febrile mothers physicians commonly interupt or delay breastfeeding,. Obstetricians in southeast Texas were surveyed for their attitudes about and management of febrile, breastfeeding mothers with 288 of 352 (82%) responding. Most believed breastfeeding is beneficial (95%), encouraged their patients to breastfeed at least 4-6 months (70%), and completed continuing education about breastfeeding in the last year (80%). Physicians estimated 50% of patients initiated and maintained breastfeeding 4-6 weeks with sharp declines thereafter. Personal and professional experience were major sources of breastfeeding information; medical school and residency education were minor sources.

Fever in breastfeeding women reportedly occurred in 1 of 3 deliveries on average. While 90% of physicians reported fever was not a contraindication to breastfeeding, 60% of those same physicians expressed concern about antibiotic transfer into breastmilk, and 27% discontinued breastfeeding until antibiotic completion. From a given list, physicians in the following percentages identified as unsafe during breastfeeding the following: 3% ampicillin, 6% penicillin, 17% erythromycin, 18% cephalosporins, 23% Unisyn, 53% clindamycin, 55% gentamicin, 80% Septra, and 96% tetracycline. The American Academy of Pediatrics lists all these as compatible with breastfeeding. Physicians very interested in breastfeeding or completing residency since 1987 were generally no more likely to correctly identify compatible antibiotics than those slightly interested or in practice longer.

Physician support is known to increase the duration of breastfeeding once initiated. We conclude many otherwise supportive physicians may inadvertently and unnecessarily discourage breastfeeding due to inadequate information about antibiotic safety. We speculate medication compatibility with breastfeeding should be a prominent part of medical school, residency, and continuing medical education.