In response to the past couple of postings on alcohol and cocaine and
breastfeeding, I am currently away from my office and all my articles on the
subject but I will post some references as soon as is humanly possilble.
All of this is to be considered as my humble but strongly felt opinion.

One of my first thoughts is not in the nature of punishment but of education and
support for this mom.  First the mom ought to be commended for providing her
baby with the best possible nutition for her wee one.  Secondly this is a mom
with obvious drug use/abuse issues and this ought to be seen as a valuable
opportunity to intervene with her on her addiction.  Often the birth of a child
is an opportunity for these women to turn their lives around but they need a non
judgemental supportive honest approach.  It also goes without saying that she
must be informed of the risks to her baby of her prenatal and now her postnatal
drug use on her baby and on her ability to safely parent.  We cannot assume that
she is aware of these risks.

Another and no less important issue is the obvious misinformation on ths part of
the Child Protactive Services.  The issue is not whether or not her drug of
choice is a controlled substance or not but rather its effects on her ability to
safely parent and the effects of her continued use on her new infant (and any
other children she may have in her care).  Their involvement does not
necessarily have to take the form of removing the child from this mother's care
but must include support for this mom to deal with her addiction (detox,
recovery home, homemaking services, parenting education etc).  And if this
child's immediate safety is an issue it must include removal at least on a
temporary basis (and I would personally advocate for her ongoing involvement
through visitation).

This family needs close follow up by pediatrician,lc, public health nurse, and
CPS.  A thorough history should be taken of all drug use in each trimester.
Growth should be monitored particularly weight and HC.  This mom should know
that her baby is at an increased risk of SIDS from prenatal and postnatal
substance exposure and of second hand smoke if she is smoking in the same home
as her infant.  This child should also be monitored closely for signs of
neonatal withdrawal and of the neurodevelopmental sequelae of prenatal
substance exposure. (This is a lengthy post already so if anyone is interested
in a more thorough explanation please email me privately).  As well if her use
is continuing the child continues to be at risk of ongoing exposure through her
breastmilk.

IMHO

Paula Robeson RN BN CBC