Cocaine in breastmilk?

[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! ;>)

[Marymoomoo]

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

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?