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Question: A patient wants assistance with breastfeeding from a Lactation Consultant. Her chart shows a history of substance abuse. A toxicology screen was sent to the lab and the results of the test were positive. What should a Lactation Consultant tell this high-risk mom?
Answer: A careful assessment of the problem is needed. Are you dealing with a recreational drug user, a recovering addict, or an individual who is in denial about her abusive habit? So often, the subject of drug abuse is difficult for us to discuss. Sometimes we avoid talking about this with our client because we feel powerless to deal with the problem. Fortunately, pregnancy helps motivate many drug abusing mothers to give up their harmful habits. The decision to breastfeed provides an opportunity for positive change. It's up to us, as providers, to encourage that change.
Let's suppose that the new mother you are to assist with breastfeeding has had little or no prenatal care and you are informed that the toxicology screening is positive for drug abuse. Before visiting the mother, meet with the baby's pediatrician and social worker, and discuss the risks and benefits of breastfeeding versus those of not breastfeeding. Whether there is evidence that breastfeeding is recommended or contraindicated in this situation, it is important to understand the rationale for the physician's recommendation, so that you can answer the parents' questions. Depending upon the drug involved, a physician may or may not advise that she nurse her baby. It is important to know what the pediatrician has recommended to the patient and to support that decision when meeting with the mother. A toxicology screen positive for marijuana is usually less alarming than a toxicology screen positive for cocaine, because there is little evidence that a mother who uses marijuana harms her baby by breastfeeding. Amphetamines become concentrated in breastmilk, causing infants to develop irritability and poor sleep patterns. Adverse effects of maternal cocaine abuse can be profound. Infants exposed to cocaine via breastmilk may develop vomiting, |
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diarrhea, irritability, tremors and seizures. Interestingly, only trace amounts of methadone are found in the milk of recovering heroin addicts participating in methadone maintenance programs, and these amounts may mitigate infant withdrawal symptoms.
After gaining approval from the pediatrician for breastfeeding, the next step is to assess the mother's true desire to breastfeed her infant. If she is motivated, then counsel about the impact of the abused substance while breastfeeding during your assessment. Emphasis on eliminating infant exposure should be made clear. It is important to provide her privacy during the discussion. It is also helpful to be encouraging and supportive of all the positive benefits there are for both the baby and the mother if she has chosen to breastfeed. A breastfeeding support group should also be recommended. Mothers with serious ongoing drug problems harm themselves and jeopardize their babies' health. Legal action may ultimately be taken to remove the infant from their custody. Sadly, there are those who are unwilling to face their addiction without these harsh consequences. For more information about substance abuse and breastfeeding, please see the September 2001 American Academy of Pediatrics Policy Statement titled The Transfer of Drugs and Other Chemicals into Human Milk at: http://www.aap.org/policy/0063.html.
Maggie is a hospital based lactation consultant for Sharp Healthcare. She is currently providing patient care at Grossmont Hospital Women's Center in La Mesa. |
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"Maggie" Mary M. Dahms RN, BSN, IBCLC.
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2001 American Academy of Pediatrics National Conference and Exhibition-San Francisco Marriott/Moscone Center, San Francisco, California, October 20-24, 2001. Attend the National Conference and you will: hear comprehensive updates from experts in the field of pediatrics; practice your techniques and apply new skills; view the latest technological advances in products and services; discuss your challenging cases; network with your colleagues from both the United States and abroad; and earn hour-for-hour AMA PRA Category 1 CME credit hours. Registration Program is available on-line at www.aap.org. |
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Sixth International Meeting of the Academy of Breastfeeding Medicine-Wyndham Hotel, Washington DC, November 1-5, 2001. The Sixth International Meeting of the Academy of Breastfeeding Medicine provides physicians with the opportunity to meet other physicians from around the world who are dedicated to an interest in breastfeeding and human lactation, share experiences in physician education and clinical management of breastfeeding patients, and attend workshops, abstract presentations, and lectures regarding relevant and controversial topics such as human milk banking, maternal depression, breastfeeding advocacy, and more. For further information please contact ABM Executive Office. Phone: (877) 836-9947 Fax: (619) 295-0056 E-mail: abm@bfmed.org Website: www.bfmed.org. LLL Conference-Costa Mesa Hilton, Costa Mesa, CA, May 25-26, 2002. More information TBA. Mark it on your calendar! |
