Breastfeeding with Blood-Tinged Milk
You do not need to discard breastmilk that contains blood unless the nipples are actively cracked or bleeding. 1
Primary Recommendation
The Society for Maternal-Fetal Medicine (SMFM) and CDC provide clear guidance on this issue:
- Breastfeeding can continue safely with blood-tinged milk in most circumstances, as there is no evidence that small amounts of blood in breastmilk pose a risk to the infant 1
- The only exception requiring milk expression and discard is when nipples are cracked or bleeding, primarily due to concerns about potential pathogen transmission through open wounds rather than the blood itself 1
Clinical Algorithm
When to Continue Breastfeeding Normally:
- Blood streaks or pink-tinged milk without visible nipple trauma 1
- Rusty pipe syndrome (common in early postpartum period when old blood from vascular engorgement appears in milk) 1
- Intact nipple skin without cracks or fissures 1
When to Express and Discard:
- Actively bleeding nipples - express milk and discard until bleeding stops 1
- Visibly cracked nipples - express milk and discard until skin integrity is restored 1
- Resume direct breastfeeding once nipple trauma has healed 1
Important Context
The rationale for this recommendation is based on infection risk rather than blood toxicity:
- The primary concern with cracked or bleeding nipples is potential transmission of bloodborne pathogens (such as Hepatitis C), not the blood itself 1
- For mothers with Hepatitis C specifically, the CDC recommends abstaining from breastfeeding only when nipples are bleeding or cracked, as HCV transmission through intact breastfeeding has not been demonstrated 1
- Blood in small amounts does not harm the infant and is commonly swallowed without adverse effects 1
Common Pitfall to Avoid
Do not automatically discontinue breastfeeding when you see blood-tinged milk. Many mothers unnecessarily stop breastfeeding due to alarm over pink or rust-colored milk, when this is often a benign, self-limited condition that does not require intervention beyond continuing to nurse 1