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Subject:
From:
"Phyllis Adamson, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 1 Jun 2005 16:39:04 -0700
Content-Type:
text/plain
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 "There seems to be some disagreement among the health care providers taking
care of an admitted cocaine user who delivered a healthy (if extremely
irritable) infant two days ago.  One recommends the mother not breastfeed
until her DAP is negative; another simply advises no breastfeeding for 24
hours.  Of course, neither condones continued cocaine use.
Any firm info about this out there?"
 
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 In Arizona, state law penalizes anyone who contributes to, facilitates, enables (the right word escapes me) a minor receiving or ingesting an illegal substance (i.e. cocaine, meth, marijuana, ecstacy, etc. in mom's milk). Based on that, our hospital wrote a policy that denies BFing help or advice to any mother who has a hx of use, or tests (+), or if her baby's meconium tests (+), for any named illegal substance. Our Social Worker has her guidelines for referrals to Child Protective Services for monitoring. The MD/DO counsels mother on the hazards to baby from BFing when these substances are in her system. The exception is: if mom is on methadone AND is participating in a rehab program, then we will assist her with BFing.

Thinking of our NICU babies, sending milk to be tested is not done at my hospital. It would have to go to a lab out of state, takes a couple of weeks for results, and our govt health insurance will not pay for it. There is a lab with that capability at another hospital, but they do only MDS, not breast milk, for other hospitals. Or it's that our hospital can't afford their fees for the testing, and it's certain that our moms can't afford it. We are a public hospital.

Most often, cocaine use is not just a one-time thing. If she did it during pregnancy, how do you KNOW she won't do it while lactating? Or after the 24-hour waiting period you mentioned? And if / when she uses again, will she know or care if 24 hours have passed? Most of our NICU RNs will not give the baby mom's milk when she is or has been (+) for cocaine or any other illegal substance. They refuse to accept the personal responsibility / liability based on how our laws are written. What happens after discharge is between the mom and CPS.

Phyllis Adamson, IBCLC, RLC
Phoenix, AZ

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