Cocaine in breastmilk? - page 2

by NICU_Nurse

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I've looked this up in two dependable resources, and both are somewhat inconclusive. If a mother is taking cocaine on a regular basis, should she be allowed/encouraged to breastfeed her infant? I'm wondering about transmissable... Read More


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    We had a similar issue with methadone. I can only speak from what was discussed regarding methadone, and I am aware that cocaine is quite a different drug.
    We had a mother who was abusing methadone and subsequently gained a newborn in the NICU that was addicted. We had him on methadone to wean him. When the mother wanted to start providing breastmilk after birth the MD wrote to allow breastmilk. When I asked for her rationale on this order she said that very little methadone crosses to the breastmilk and that some studies have shown the minimal amounts of methadone can actually help the baby to detoxify slowly from the drug.
    Like I said, I know cocaine is different-but I imagine the same argument could be made for it as well. We see very few cocaine users in our NICU population-thankfully!
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    Our moms that take methadone are encouraged to breastfeed/pump. I'm not on the NI side of the nursery so I'm not sure if the story is the same over there. We do most of the methadone withdrawals in our nursery, not in NICU.

    Our moms that use illicit drugs can breastfeed if they want. Granted, they are not feeding fragile preemies - at the earliest 34-35 weekers, who have their own set of issues but they do get to BF.

    I wonder how many drug users we are missing by doing a UDS only on select groups.
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    I know this is an old thread but I have a question re: drugs/breastmilk/nicu

    So I have a nicu grad born 32w4d. She has only ever had breast milk. She was in a level III nicu for 30 days during which time I was recovering from a particularly difficult section and a subsequent surgical infection (wound vac/homehealth care nurses...whole bit)


    So essentially the whole time my little one was in the nicu I was on pain meds. I was with her at least 12 hours a day and my husband was with her another 4-6 (we have two other kids a home so he was doing most of their care while I was with the baby and dealing with my medical stuff)

    My question is...clearly I was compromised. Clearly if I had been drug tested I would have been positive for narcotics...so how is that different then someone being positive for street drugs in relation to the amount of transference of meds to the baby?
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    I can't speak to the ethics of your question; however, I remember working on a postpartum unit and mothers took Tylox and Percodan for pain and were sent home on these medications to use as needed for postpartum pain. The OB doctors said that the amounts that pass through the breast milk are so small (when Mom's take the ordered doses) that an effect, if any, would me quite minimal and really insignificant. I know that there are some drugs that do cross over into the breast milk and some that don't. There is a book on our NICU unit that our neonatologists consult in such situations. It seems that the drugs that are super strong antibiotics, heart drugs, and chemotherapy drugs are the ones that stand out in my mind as the ones that mom's have to pump-and-dump until they are off of them. I also have heard the same information about the methadone as mentioned in a couple of posts above. We often test the breast milk of our methadone moms to look for drugs other than methadone... HIV positive Moms are not allowed to breast feed as the virus passes through the breast milk.
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    Yes the book is called Medications and Mother's Milk by Dr Thomas Hale and most narcotics (percocet, vicodin) pass in very limited amounts to the baby although in rare cases especially in neonates it can lead to decreased respirations. I guess my question was more of an ethical one. Thank you for your response.
    Love_2_Learn likes this.
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    I have always known breastfeeding to be contraindicated in mothers who use cocaine. Here is what I found in Gomella: Neonatology; Management, Procedures, On-Call Problems, Diseases, and Drugs. 6th ed.

    Cocaine: Contraindicated. Cocaine intoxication in the breast-feeding infant from maternal intranasal use (hypertension, tacycardia, mydriasis and apnea), topical use on mother's nipples: apnea and seizures. We also know that maternal cocaine use during pregnancy has been linked to spontaneous intestinal perforation. Would you really want to give your 23 weeker breast-milk from the cocaine addicted mom???

    Methadone: excreted in low concentrations, compatible per AAP

    Codeine: short-term therapy ok with close monitoring in healthy full-term infants, long-term therapy not compatible w/breast-feeding. Observe for sedation, lethargy, and poor feeding..per AAP it is compatible.

    I hope this helps.
    Love_2_Learn likes this.
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    I'm not sure about cocaine passing through breast milk but I do know other common drugs can. My mom had been put on a perscription after my sister was born and told repeatedly by her doctor that it would not pass through the breast milk to the baby. Well sure enough it did! My sister was passed out! My mom would wiggle her, gave her a bath, did everything she could to wake her baby up and nothing. Sure enough it was the medicine the doctor had put my mom on and knocked the baby out. Sometimes doctors really just don't know how much the baby could actually be getting.
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    Quote from NICU_Nurse
    I've looked this up in two dependable resources, and both are somewhat inconclusive. If a mother is taking cocaine on a regular basis, should she be allowed/encouraged to breastfeed her infant? I'm wondering about transmissable cocaine levels...how does this affect baby? I know that cocaine in utero can lead to behavioral or developmental delays, but what about consistant exposure to it via breastmilk? My first resource says the effects are unknown, and the second says that chronic users should be discouraged from breastfeeding but otherwise should go ahead and give the milk without pumping/dumping. Any thoughts on this? Thanks! ;>)
    The last time I had a Neo say that a Mom could breastfeed when she was on 11 different drugs, three of them opiates, I stopped asking. All of them were secreted in breast milk to some degree.

    All of our mothers that are on methadone, subutex, suboxone, all breast feed....these are NOT contraindicated for breastfeeding.
    oklahomagal likes this.
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    Quote from Laurensue9
    I'm not sure about cocaine passing through breast milk but I do know other common drugs can. My mom had been put on a perscription after my sister was born and told repeatedly by her doctor that it would not pass through the breast milk to the baby. Well sure enough it did! My sister was passed out! My mom would wiggle her, gave her a bath, did everything she could to wake her baby up and nothing. Sure enough it was the medicine the doctor had put my mom on and knocked the baby out. Sometimes doctors really just don't know how much the baby could actually be getting.
    I would wager it was something else that caused that, if you were told the story accurately by your sister.

    It is not a matter of "doctors don't know how much a baby is getting"...moms are on some pretty heavy pain medications, especially after c-sections. These drugs have been heavily researched and it is why certain ones are used after a birth, in case mom decides to breast feed.

    I have never, ever heard of a baby getting so sedated that it actually passes out from meds from breast milk...ever.
    oklahomagal likes this.
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    Quote from Elvish
    Our moms that take methadone are encouraged to breastfeed/pump. I'm not on the NI side of the nursery so I'm not sure if the story is the same over there. We do most of the methadone withdrawals in our nursery, not in NICU.

    Our moms that use illicit drugs can breastfeed if they want. Granted, they are not feeding fragile preemies - at the earliest 34-35 weekers, who have their own set of issues but they do get to BF.

    I wonder how many drug users we are missing by doing a UDS only on select groups.
    That is not good, because methadone is not contraindicated.

    Remember, evidence based...and the practice of your nursery is not based on evidence.

    Methadone is considered COMPATABLE with breastfeeding by the American Academy of Pediatrics and by any lacation drug-compatability book you will find.

    The mother simply needs to be told that SHOULD she suddenly stop breastfeeding if she continues to take methadone...that withdrawal symptoms could increase.

    I work in a Level III with three full-time lactation consultants and I have never, ever seen a mom on any prescribed drug-program of ANY kind, be told she has to "pump and dump".

    It is amazing the number of people that are posting that obviously, do not look up the drugs mother is on. They are wasting a huge benefit to the baby.
    oklahomagal likes this.


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