Cocaine in breastmilk? - page 2

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... Read More

  1. Visit  Love_2_Learn} profile page
    0
    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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  3. Visit  Nicugradmama} profile page
    1
    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.
  4. Visit  mom to a PRINCESS} profile page
    1
    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.
  5. Visit  RN2B2014} profile page
    0
    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.
  6. Visit  BabyLady} profile page
    1
    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.
  7. Visit  BabyLady} profile page
    1
    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.
  8. Visit  BabyLady} profile page
    1
    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.
  9. Visit  Elvish} profile page
    1
    BabyLady - I'm not at all sure what you read, but my post clearly says we encourage our moms on methadone to breastfeed or pump (note I didn't say pump and dump). We withdraw way more kids in our nursery than NICU does and have a great deal of experience with methadone and breastfeeding.
    DeLanaHarvickWannabe likes this.
  10. Visit  BabyLady} profile page
    1
    Quote from babynurselsa
    I refuse to feed breast milk to an infant of a mom who is + for anything more than THC. A personal decision on my part.
    If that doc wants that kid to get the breast milk and it was my pt she better come and feed it herself.
    They let nurses make those decisions in your unit?

    In my unit the Neonatologist gets to make those decisions, not nurses.

    ...by the way, its funny that you think that THC is somehow "more" safe than other drugs that Mom is on....that too, is not based in evidence.

    THC is fat soluble, passes in breast milk and builds UP in the body. It is actually detectable in fat cells in the brain of the infant and is detectable in the urine and feces.
    oklahomagal likes this.
  11. Visit  BabyLady} profile page
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    Quote from Elvish
    BabyLady - I'm not at all sure what you read, but my post clearly says we encourage our moms on methadone to breastfeed or pump (note I didn't say pump and dump). We withdraw way more kids in our nursery than NICU does and have a great deal of experience with methadone and breastfeeding.
    By even recommending it, that is not based on evidence.

    Seriously...someone in your unit needs up-to-date information on breastfeeding and it's compatabilities and I would highly encourage staff education from a licensed lactation consultant.

    ALL of the withdrawal infants in my facility come up to the NICU..all of them. We are in one of the most drug-infested cesspools in the USA and almost 50% of our mothers test positive for something, drugs of abuse or not.

    So whoever came up with that idea...to even encourage it, needs to be educated on breastfeeding guildelines and recommendations.
    oklahomagal likes this.
  12. Visit  Elvish} profile page
    1
    If methadone is compatible with breastfeeding, as you've stated over and over and no one is disagreeing, how exactly does it go against evidence-based practice for us to allow it, and why does that indicate a need for the entire staff to be educated with lactation consultants? (who, by the way, are perfectly fine with what we do.....) Please do share, because I'm not following this logic.
    DeLanaHarvickWannabe likes this.
  13. Visit  Marymoomoo} profile page
    0
    Quote from Nicugradmama
    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?
    Different drugs pass into breastmilk at different rates, and different drugs are absorbed at varying levels. There are variations of drug transfer from mom to baby based on how the med is absorbed, dosage, plasma level, half life, whether the drug is rapid or sustained release, dosing interval, stage of lactation (open vs closed junctions), etc. Then there are variations of transfer of meds to the milk itself by lipid solubility, pH, molecular size, levels of med in moms' plasma, protein binding, oral bioavailability (to both mom and baby, half life of the drug, etc. Here's a more in depth explanation: Drug Entry Into Human Milk

    To sum up, it would be possible for a mom to test positive for some drugs, but none to be detectable in her baby's blood after breastfeeding. Remember, too, that an infant is only receiving a fraction of the drug the mom took through her breastmilk (again, that varies according to how much passes into the milk itself, and how bioavailable it is to the baby through the milk).

    Here are some resources that you might find helpful:

    InfantRisk Center--Practitioners, nurses, IBCLCs, lay breastfeeding support, and parents can call the center to get up-to-date, evidence based information about the use of medications and drugs during pregnancy and lacation.

    LactMed online database search from the NLM

    Medications and Mothers' Milk book

    Nonprescription Drugs for the Breastfeeding Mother book


    Academy of Breastfeeding Medicine: Analgesia and Anesthesia for the Breastfeeding Mother




    Quote from BabyLady
    By even recommending it, that is not based on evidence.

    Seriously...someone in your unit needs up-to-date information on breastfeeding and it's compatabilities and I would highly encourage staff education from a licensed lactation consultant.

    ALL of the withdrawal infants in my facility come up to the NICU..all of them. We are in one of the most drug-infested cesspools in the USA and almost 50% of our mothers test positive for something, drugs of abuse or not.

    So whoever came up with that idea...to even encourage it, needs to be educated on breastfeeding guildelines and recommendations.
    To encourage...breastfeeding? Which evidence are you discussing?


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