Typically we recommend she breastfeed if she is stable on her methadone treatment, hasn't relapsed in the previous 30 days, and urine drug screen is negative for other drugs (and of course HIV negative). Methadone transfers pretty poorly into milk so the baby is still going to go through withdrawal. We call them NAS babies. Neonatal Abstinence Syndrome. NAS babies usually stay in our hospital a minimum of 5 days after delivery. Withdrawal symptoms are usually worse with higher doses of methadone and better with lower doses. I typically find that they often nurse really well at delivery and pretty well during the first 24 hours. After that the withdrawal symptoms start to peak and they really go downhill with breastfeeding for a few days.
I have a lot of problems with helping the NAS moms breastfeed and would love any tips that others have found. I try talking to them ahead of time about the likely scenario and being realistic, but things go well on the first day and they often do not want to believe that the baby is going to be affected. Then they are very disappointed when the second day doesn't go well. Many of them get frustrated and give up. The levels of methadone in the baby's system start to decrease on that day and most begin high pitched crying, irritability, lots of shaking and jerky arm movements. I find they also tend to drop weight rapidly then. It is a real challenge to get any of them through a hospital stay without formula supplements.
Not only do they not latch for most of the feedings, they are burning so many more calories because of the increased shaking and body movements, I think. The typical situation I encounter is on the first day I try to talk to them about the fact that the baby will likely begin showing increased signs of withdrawal and poorer feeding in the next 24 hours. I recommend that they breastfeed and follow up with giving additional expressed breast milk (we have them hand express). Most moms though don't seem to want to express milk. They tell me the baby is feeding fine. The next day, the babies latch for 2 minutes, come off the breast crying and then lose 8% of their body weight and then the Pediatrician orders formula. We recommend a lot of skin to skin contact which helps them cry less but they don't latch any better. Then start her pumping but it's a few days before their milk increases.
Usually in a couple days the mothers are able to pump more milk, but it's rare that the mothers are consistent with their pumping. Many just seem to switch to formula right away. They generally have fewer coping skills and get very frustrated with it. An SNS usually doesn't work either. They are pretty poor feeders, often they are really poor bottle feeders as well for a few days. It's a struggle to get calories in them. It's really, really rare that one makes it through the hospital stay without formula. It's usually the rare mother who can pump 15 ml on the second day and actually pumps every 2 to 3 hours. Some of them will do better with a nipple shield with an SNS of formula inside for a few days but not always. I wish we had donor milk for these babies and someone to hold them 24 hours a day. It's a real problem. We always have at least 1 to 2 of these babies in our nursery. Some of them will be her up to 2 weeks depending on their symptoms. This is a real epidemic unfortunately.
Tricia Shamblin On Thursday, August 23, 2018, 11:00:35 PM CDT, LACTNET automatic digest system <[log in to unmask]> wrote:
There are 2 messages totaling 60 lines in this issue.
Topics of the day:
1. request for information (2)
Lactnet Archives are at:
LACTNET Archives http://community.lsoft.com/archives/lactnet.html
To Manage your Subscription, ie go nomail, index, etc, go to:
http://community.lsoft.com/archives/lactnet.html
Thanks!
LACTNET Facilitators
Kathleen B. Bruce RN, BSN, IBCLC
Rachel Myr, midwife, IBCLC
Kathy Koch PhD
Linda Pohl
Karleen Gribble PhD
Norma Ritter, IBCLC
Nina Berry PhD
Questions to [log in to unmask]
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
----------------------------------------------------------------------
Date: Thu, 23 Aug 2018 13:11:24 -0400
From: Nikki Lee <[log in to unmask]>
Subject: request for information
Dear Lactnet Friends:
Does anyone have experience with a breastfeeding mother who has abused
opioids? I am curious about how healthcare professionals provide care in
such situations, and looking for case studies and protocols. Thanks in
advance.
warmly,
--
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
Reviews Editor,* Clinical Lactation*
www.nikkileehealth.com
https://www.facebook.com/nikkileehealth
*Communications are confidential and meant only for whom they are
addressed.*
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
------------------------------
Date: Thu, 23 Aug 2018 19:35:21 -0400
From: Patricia Young <[log in to unmask]>
Subject: Re: request for information
The newest plan is for mom to be on methadone and breastfeed. Of course she also needs to be in a counseling program of some sort so she doesn't use opioids. Baby does better with NAS if breastfeeding. Pat in SNJ
Come over to visit and read our fat file on opioids and NAS :-)
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
------------------------------
End of LACTNET Digest - 22 Aug 2018 to 23 Aug 2018 (#2018-227)
**************************************************************
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
|
