Mary, This mom should be helped. I am no expert on this situation, but
I have worked as hospital LC with a few moms in this predicament.
A few suggestions:
Involve the whole team - ob, peds, nursing, social services, etc as appropriate.
Document in the medical record carefully, factually, including quoting
exactly what mother says she will / won't do.
Help her to succeed by referring to some drug intervention program,
halfway house. Some moms are on methadone or similar substance and are
monitored.
Social services can help with referrals.
Often there are public health programs for high risk families and they
make home visits, check on baby, and ensure baby goes to appointments.
Parenting programs may be available and that is something for her to enroll in.
However, be aware that some of these women are liars (this is part of
addiction) and will be saying they want to get clean and breastfeed as
just a smokescreen to avoid prosecution, removal of infant from their
care, etc.
Tough situation all around.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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