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Lactation Information and Discussion <[log in to unmask]>
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Wed, 11 Oct 2000 10:22:18 EDT
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I wish that alcohol was the benign drug that several posters have mentioned.

I practice pediatrics in the heart of Gallo Wine Country (corporate HQ is in
Modesto) and the center of Methamphetamine production in the United States.
Heroin is also a popular drug of choice in my community.

Some of the mothers in my practice have a very different perception of what
is "occasional" drinking from what has been described.  Heavy binge drinking
to counteract the effects of the Methamphetamine (as a downer) is not
unusual.  Very few folks abuse only one substances these days.  Some who
abuse meth (or crank) also use prescription drugs (sedatives,
benzodiazepenes), heroin as well as alcohol.

I have quite a few children in my practice with fetal alcohol syndrome.  A
substantial number of my patients are also in the foster care system due to
parent neglect secondary to their parents drug and alcohol problems. I also
am the medical director of a Perinatal chemical dependency program.  Part of
what I see is that many times parents underreport their usage of mood
altering substances along with health professionals who don't know how to
tease the information out.

I am reluctant to tell my parents with drug and alcohol problems-oh yes go
ahead and drink.  For those who have significant chemical dependency issues,
moderation doesn't work.  Abstinence is key.

In the last month, one of my patient's moms had two DUI's (driving under the
influence) during the early part of the pregnancy along with a requirement to
stay in sobriety and participate in a drug treatment and drug diversion
program.  This mom's drug of choice is phencyclidine (PCP) but came up with
two "dirty urines" for alcohol one week postpartum.  The court didn't look
too highly on this as she was also breastfeeding.  Now she is incarcerated
for violating the agreement of her drug diversion.  A tragic situation with a
mom who cannot stay clean, a baby who is now separated from her mom and a
very angry paternal grandfather trying to sort through his denial of his da
ughter's addicition.

These are the cases I deal with on a daily basis.  Not the "can I have a wine
with dinner sort of thing."  My approach is "if you can stay clean- by all
means breastfeed."  I also do not tell the tobacco smokers in my practice to
stop breastfeeding.  Rather I work with the parents on smoking cessation
techniques and strategies to minimize their children's exposure to
environmental tobacco smoke.  So I practice a mixture of harm reduction and
abstinence techniques with my families.

From the trenches,

Pierrette Mimi Poinsett MD FAAP
Modesto CA

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