Hi, Patti: You have brought up an issue that is very complex and multi-
faceted. In order to provide the best possible care for the mother-baby
couplet, you must be working as part of a health care team that includes
physicians (both mom and baby's), counselors, social services, possibly
psych services, and various community agencies and services.
People who abuse tobacco, alcohol, and drugs tend to adhere to a certain
lifestyle that tends not to be conducive to developing good safe parenting
practices. All these things need to be explored with the mother - is she
willing to and can she make positive changes in her lifestyle that will
allow her to parent her baby in a loving and safe manner? In some
instances the answer will be "no" and in all instances she and her baby
will need a lot of support from her family, friends, and professionals.
The general rule of thumb is that she not breastfeed if she cannot give up
her drug use. Many of these moms realize that their lifestyle choice is
not conducive to breastfeeding and make the choice not to breastfeed so as
not to endanger their baby's health. Others feel strongly about
breastfeeding and make the choice to change their lifestyle for the
better. These moms need intensive and long-term follow-up. I used to work
in a research-based program thru the local health department. The program
is called Nurse-Family Partnership and is based out of the University of
Colorado. The purpose of the program is violence prevention - cut into the
circle of poverty and violence. We recruited teen moms into the program
during the pregnancy and followed her thru pregancy, labor/delivery,
immediate post-partum, thru the baby's 2nd birthday. It's a wonderful
program for both the mom/baby and the HCP. I was able to mentor the young
mom, helping her to develop positive parenting skills (many of these young
moms had no or poor role models in their own mothers) and watch her and her
baby grow over 2+ years. With this type of intense follow-up (visist were
weekly and bi-weekly) many of these moms were able to say "no" to drugs and
poor lifestyle choices. Three of the 3 moms I worked with went on to
nursing school - they told me they were impressed with the influence I had
on their lives. One mom told me the only reason she stayed in high school
was because of me. She invited me to her high school graduation. I also
attended the wedding of one of my moms - she and her husband are both
finishing college now and their little girl is absolutely adorable!
Good luck in your work with these moms. It's difficult but oh-so-
rewarding! Can you tell I miss my "girls"?
Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL USA
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