Reading Ann's list of contraindicated drugs, the recreational/addiction
drugs got me thinking--

(1)  What if they weren't contraindicated?  How would this change our advice?

(2)  Recreational drugs are contraindicated for all mothers of babies
because they impair judgement and functioning.  Nicotine probably doesn't
impair judgement much (except in actions related to cigarette smoking), but
is dangerous for other reasons.  Will your nurses understand, also, that
contraindicated doesn't necessarily mean "don't breastfeed"?

(3)  What if a dangerous drug habit, such as heroin use, is to continue?
Will the greatest risk be to the formula fed baby, whose intake of any
nutritious foods at all is compromised, or to the breastfed baby, who will
likely receive more and better food, but with an unhealthy additive?

(4)  I talked to an LC at Georgetown in '93 who worked with women who were
drug abusers and breastfeeders.  She found the best hope was to support
initiation and continuation of bf in most instances, along with other
support.  I haven't had to find out much more about it, but there are LC's
who see this in their practice every day.  How do they handle it?

Your target audience is staff nurses, who will mostly be trying to think
about the safety of drugs potentially given to their breastfeeding
patients.  I guess I don't see much point in adding drugs of abuse to the
contraindicated list unless we have a strategy in mind.

Also, what about a list of NON-contraindicated drugs (which of course would
be longer), such as the AAP list?

Your self-study module on compatability of drugs and bf is a great idea.

Arly