Breastfeeding during Drug Treatment

Women who struggle with addiction to drugs or alcohol need specific treatment, which may include care during pregnancy or just after childbirth. Breastfeeding is a controversial issue among women who are working to overcome addiction and give birth before or during the course of their recovery process. There are some benefits for women in recovery and their babies when they breastfeed; however, these psychological benefits must be weighed against potential long-term risks to the child.

About 4.6 million women, representing about 3.8 percent of the women ages 18 and older, struggle with substance abuse. Women who give birth while dealing with addiction may have infants who develop neonatal abstinence syndrome (NAS) because intoxicating substances and some prescription drugs pass through the mother’s blood and can affect the baby’s development. After the child is born, drugs continue to pass through breastmilk; this can affect the child’s physical, mental, and behavioral development.

How Drugs Transfer into Breastmilk

Drugs can pass into the mother’s breastmilk, and if she still struggles with addiction, substances of abuse may continue to affect the child’s brain and body as it grows. Some detox drugs, like buprenorphine, may also pass into the breastmilk, so risks must be weighed against benefits.

Substances that can pass into the breastmilk and begin to affect the child include:

• Alcohol: Abusing alcohol during pregnancy can cause fetal alcohol spectrum disorders (FASDs), and during breastfeeding, alcohol can continue to cause harm. Anecdotes suggest that drinking a moderate amount of alcohol increase breastmilk production, but scientific studies have found that this is not true. Instead, alcohol in breastmilk can hurt a child’s sleep cycle.
• Nicotine: Although 16 percent of pregnant women in the US have smoked in the past month, this is one of the most harmful substances to use while pregnant as it damages physical, behavioral, and mental development of the fetus. After birth, if breastfeeding, nicotine continues to pass through breastmilk into the infant and will continue to harm the baby.
• Marijuana: Some studies suggest that a small amount of THC enters the breastmilk, and this can affect children exposed in the first month of life, influencing motor coordination skills up to the time they are 1 year old. It is also possible that THC in breastmilk could affect the child’s brain development, but fewer studies have been conducted on this problem.
• Some prescription medicines: The American Academy of Pediatrics (AAP) keeps a list of prescription medications that are safe during breastfeeding. Women who have questions about their prescriptions and how these drugs may affect their child during pregnancy or breastfeeding should consult their physician, as not all medications have known effects.

The Detox Process and Breastfeeding

Babies born with mothers who are struggling with addiction are at risk of developing neonatal abstinence syndrome (NAS). This is a form of withdrawal that requires medical intervention to keep the child safe; however, symptoms in most infants go away within one week after birth. Some long-term health effects, including mental and behavioral damage, may be ongoing.

A woman who detoxes after her child is born is not likely to put her baby at risk except from a few forms of detox that involve medication-assisted treatment (MAT). Both buprenorphine and methadone can transfer into breastmilk, which can affect the child’s development. A longitudinal survey of babies exposed to methadone, for example, found that at 9 months old, about 37.5 percent of the sample struggled with motor development delays. However, if an infant is exposed to opioid abuse in utero, they may be given very small, controlled doses of methadone or buprenorphine after birth to ease withdrawal symptoms, so the risk of exposure must be balanced with other risks. Buprenorphine, in contrast to methadone, was metabolized less readily into breastmilk, so it may be a better option for breastfeeding mothers who wish to begin the opioid recovery process.

Babies with NAS from opioid addiction in particular benefit from physical contact, gentle rocking, and other forms of comfort. Breastfeeding may be comforting, and the process appears to help mothers too. Women recovering from opioid abuse emotionally benefit during the breastfeeding process, so the prescription of detox drugs should be balanced with the potential benefits of physical contact reducing stress and the infant’s experience of NAS.

Help for Women and Parenting Choices in Recovery

A woman overcoming addiction to drugs or alcohol should be supported in her choices for herself and her parenting choices; ideally, physicians, nurses, and therapists will all be available to coordinate care for the woman in recovery and her child.

They can help the mother understand risks associated with potential medication management and how she may be able to detox without taking medications.