In response to Jay's post about the mom who is using heroine during her
pregnancy:

       I am a Nurse Clinician and have a certificate in Breastffeding
Counselling.  I am no expert on breastfeeding but very much a supporter and
advocate.  I do have considerable experience working with moms and their babies
where there is an issue of prenatal substance use.  First if a mom has actually
completed a methadone program that is is no longer taking and methadone an d no
other substances than her baby will not go through withdrawal.  However if she
remains on the methadone her baby is at risk for withdrawal.  The withdrawal
from methadone can be somewhat delayed that is the first symptoms can manifest
at birth or up to 14 days following.  If a mom is also breastfeedin depending on
a number of factors including the mom's dose the withdrawal may be delayed.  My
experience has been that infants withdrawing from methadone have a more severe
and prolonged withdrawal than infants withdrawing form heroine.

Other concerns for me are whether this mom is having sucessin her recovery from
heroine and or methadone.  Addiction is a disease that is often associated with
relapses.  The effect of her drug use as it impacts on her ability to safely
parent this child is of a primary concern.  Mom will need considerable support
in maintaining her recovery during what can be a period of stress and
readjustment as well as with her breastfeeding.

My experience is that withdrawal can sometimes be delayed from heroine t in an
infant who is brestfed.  But I would not advocate this as a method of weaning
particularly if street drugs are invlved as often the drugs are laced with other
substances.

In addition poly drug use is a common phenomenon and often the drug named as the
only drugs used are actually the drugs of choce but many other substances are
also used.

We must balance the risks to this baby of the drug exposure postnatally to the
risks of not breastfeeding (increased infections, poverty and therefore
insufficient food or improperly mixed formula, Attachment ANd the list could go
on and on).  I have no clear answer and continue to struggle with this.

There are many articles related to breastfeeding and substance use. Some
references I have listed below:

        Briggs,G,Freeman,R,and Yaffe,S (1994)Drugs in Pregnancy and Lactation.

        Anderson,p.o (1991)Drug use during breastfeeding. Clinical Pharmacology.
10:595-624

        D' Apolito,K(1994). Methadone maintenance and breastfeeding:do they mix.
Neonatal Network.13(8):64-5.

        D'Apolito, K, (1995)Methadone maintenance and breastfeeding
continued.Neonatal Network. 14(4):77-8

        American Academy of Pediatrics (1994). The transfer of drugs and other
chemicals into human milk. Pediatrics. 93(1):137-150.

As well as our own Dr. Hale's book

As i have said previosly on Lactnet I am in the process (albeit a slow one ) of
conducting a lit search on this topic.  I will keep you all posted.

Ending my stint on the soapbox, for now.

Paula