Molly Scarborough McMillion RN, BSN, IBCLC, LCCE, CPST
I am have been a RN for 30 years, Lactation Consultant and Childbirth Educator for 19 years and have worked in the Greenbrier Valley for the past 18 years working with moms and babies. I started the Greenbrier Valley Drug Free Mother Baby Greenbrier Valley program in 2011, and have personally worked with mothers, infants and families with substance exposure throughout their stays. I am passionate that mothers with substance use disorder be treated compassionately and with utmost respect. In my work as both lactation consultant (locally in GBV) and as the Director of the WV Breastfeeding Alliance, I have been witness to many situations that could have been handled much better given current & evidence based information and compassion. Too often mothers don’t have all the information and confidence they need to be successful and there’s help available! You’ve probably heard “breast is best” but have you ever considered why? How about – breastfeeding will help me bond better with my baby? Here’s the thing, both are true –only breastfeeding is not best – it’s normal and what our bodies are designed to do. New moms have all kinds of worries and fears. Mom’s who are in treatment for substance abuse worry about LOTS of additional things. Although most people don’t realize it, mothers whose infants go through withdrawal feel a tremendous amount of guilt, shame and so much fear for their babies. Breastfeeding can be a bridge to help mothers feel like they are helping their babies – even making their babies feel better during a truly stressful time. In truth, YOU are the medicine that your baby needs!
3 things to know
- Breastmilk is the best most complete form of nutrition for infants.
- Today’s formulas are good, but are all trying to reproduce all the great stuff in breastmilk.
- A mother’s milk gives baby protective immunities that cannot be made and put into formula.
- Mother’s milk changes from feeding to feeding (how much of each nutrient – carb, protein, vitamins & minerals and ANTIBODIES- according to what baby needs
- Anything mom has ever been exposed to (cold, flu (even COVID-19) chickenpox and vaccines mom has had) have caused mom’s body to make “antibodies” to these and these are given to baby to prevent illness or at the very least lessen the severity of illness.
- You can pump your milk and give it to baby if baby won’t latch or you are uncomfortable putting baby to your breast to feed.
- Any breastfeeding however brief, can decrease the infant’s need for treatment with medication for NAS and the length of drug therapy and time in the hospital
- Most medications are compatible with breastfeeding, though it is important for baby’s doctor to know exactly what you are taking to be sure.
- Very little of your medications (subutex or suboxone or methadone) goes to baby
- Just breastfeeding and holding your baby can decrease symptoms of withdrawal
- Studies have shown that infants who are breastfed have shorter hospital stays Schiff D, Wachman E, Philipp B, Joseph K, Shrestha H, Taveras E, Parker M. Examination of Hospital Maternal and Infant Characteristics Associated with Breastfeeding Initiation and Continuation Among Opioid-Exposed Mother-Infant Dyads. Breastfeeding Medicine Vol. 13 No. 4 2017
- Moms should know when it’s okay to breastfeed and when they should not
You can breastfeed if:
- You are in treatment and have provided your consent to your doctor and baby’s doctor to discuss progress in treatment and plans for postpartum treatment with substance abuse treatment counselor
- Your counselor confirms that you have been able to achieve and maintain sobriety during pregnancy; (and counselor approves of your plan for breastfeeding)
- You plan to continue in substance use treatment after baby is born
- You have been abstinent from illicit drug use or licit drug use for 90 days prior to delivery and have demonstrated the ability to maintain sobriety in an outpatient setting
- You have a negative drug test at delivery except for prescribed medications
- You have received consistent prenatal care
You should not breastfeed if:
• You are HIV-positive,
• You have tuberculosis
• You have cracked or bleeding nipples and are hepatitis C-positive
• You are using again- including marijuana
- Mothers who are hepatitis B or C positive may breastfeed (American Academy of Pediatrics [AAP], Section on Breastfeeding, 2012; Centers for Disease Control and Prevention [CDC], 2015).
- The CDC (2016) describes other situations in which a mother should avoid breastfeeding.
Why should you care? What should you do next??
Breastfeeding your infant is your right and has too many positive benefits for your baby (and for you!) to not at least try!
Do your homework – take a breastfeeding class, read a breastfeeding book (“Breastfeeding Made Simple” by Nancy Mohrbacher is an awesome book -and she also has a “Working and & Breastfeeding Made Simple” version too if you are returning to work)
Or go to a reputable website like Kellymom.com (https://kellymom.com/category/pregnancy/bf-prep/ ) Most of all get help from a trained lactation consultant who has experience with babies going through withdrawal it can make a world of difference!! I personally am happy to talk to you (you can text me @304-667-4362 or email me @email@example.com and I can refer you to someone closer to where you live if you need ‘hands on’ help!
Academy of Breastfeeding Medicine Protocol #21 Guidelines for breastfeeding and the drug-dependent woman—Revised 2015_ https://www.bfmed.org/protocols
Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and their Infants. https://store.samhsa.gov/sites/default/files/d7/priv/sma18-5054.pdf
“Maternal substance abuse is not a categorical contraindication to breastfeeding. Adequately nourished narcotic-dependent mothers can be encouraged to breastfeed if they are enrolled in a supervised treatment program and have negative screening for HIV and illicit drugs.”(American Academy of Pediatrics Breastfeeding and the Use of Human Milk AAP Policy Statement 2012) PEDIATRICS Vol. 129 2012 pp. e827 -e841