I need your collective wisdom to help me answer this one...

We (at the hospital) sometimes have moms who are cocaine users and we
know it before they actually deliver. We have one now who just delivered
and the question still comes up...

Those moms are usually known in the community and followed by a social
worker.  The s.w.communicates with us at the hospital when mom comes to
deliver. We usually test baby's urine soon after birth to confirm or
infirm that the mother has taken the drug during the last 72 hours.

The problem is...some doctors and nurses feel we should not let the
mother start breastfeeding if we know there will be no important and
secure significant other at home afterwards, this for the child's
safety. Mom knows her baby is being screened and that child protective
services could remove the baby from her because of illegal drug
consumption, so many prefer bf to bottle to avoid this.

I believe those moms and babies could benefit from bf, closeness,
importance of the attachment to the newborn, etc...even with the drug in
their milk, but I am also aware that most of those kids are then removed
from their moms during the first few months because of failure to thrive
or negligence,...

Our community has been lucky not to have many substance abuse moms for
many years but we see it more often now and don't quite know how to
stand on this matter. What are your ideas or experiences on this? Thank
you.

Louise Dumas, R.N., M.S.N., PhD
Professor-researcher in Nursing Sciences
University of Quebec in Hull