Brenda & others:
We rewrote our policy on BFing Infants of Substance Abusing Mothers last year. Here is what it says:

1. Mothers wishing to breastfeed should be encouraged to do so, except under the following conditions. Mother admits to current use of illicit drug(s). A positive drug screen is obtained on mother or infant.
2. All of the following illicit drugs are contraindicated by the American Academy of Pediatrics for use by breastfeeding mothers: Amphetamines (Meth, Ecstasy, Adam, Eve, Harmony, Love, Ice, etc.), Cannabis (Marijuana, Pot, etc.), Cocaine (Crack, Coke, Speedball, etc.), Heroin (Speedball, etc.), LSD, PCP (Angel Dust, etc.).
3. The Attending Physician for either the mother or the infant will notify the mother of the positive drug screen. The physician will instruct the mother not to breastfeed and will provide education nto the mother of the risks to the infant of breastfeeding or breast milk feeding with these drugs in the milk. Nursing staff will not assist mother with breastfeeding or pumping. Nursing staff will not store the mother's expressed breast milk, nor feed it to the infant. Nursing staff can inform mother of palliative measures to reduce and stop lactation, and how to avoid mastitis.
4. If the mother attempts to or does put the infant to breast, or if she hand expresses or uses her own personal pump in a manner to collect and save the milk, staff will inform the Social Worker who will then inform CPS.
References:
AAP: Breastfeeding and the Use of Hjman Milk
AAP: The Transfer of Drugs and Other Chemicals Into Human Milk
Breastfeeding: A Guide for the Medical PRofession...
Drugs in Pregnancy and Lactation (Briggs....)
Medications and Mothers' Milk (Hale...)

Me again:  This came to our attention as nurses read the AZ Revised Statutes about punishments to persons who enable a baby/child to receive or consume an illegal substance and they were refusing to accept any mother's milk when there was a suspicion of illegal drug use. They would to a MDS on baby's diaper. About the same time, a large hospital chain in Phoenix wrote their own similar policy. The LCs may do a chart review and write recommendations, but we do not personally see these women.

In Jan 2005, Guidelines for Identifying Substance-Exposed Newborns was published by the Governor's Action Plan on Child Protective Services Reform; Substance-Exposed Newborn Committee. It can be found on the Az Dept of Health Services website   www.azdhs.gov

Brenda: One of the Committee members is from your hospital: Kelli Sieczkowski, Social Work Manager. She or her colleagues may be able to help you with writing or rewriting your policy.

Phyllis Adamson, IBCLC, RLC
Glendale, AZ
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