My question is:  why is the health care team even debating the utility of
teaching a mother, who has stated her desire to do so, to pump milk (to
protect her supply now, and to offer to her baby either now or later)
despite that positive-test for street drugs?

Why are there lingering feelings of unease by the staff in teaching about
breastfeeding (including my favorite monster-under-the-bed ... a lawsuit
down the road) when the overwhelming clinical evidence tells us of its
efficacy for both mother and baby?

Could it be that there is a bit of "judgment passing" going on about this
mother's history? Perhaps some assumptions about how "good" a mother this
is, or will be?  THAT is the more troublesome ethical scenario ... because
that means healthcare is being provided based on "feelings" and not
evidence-based practice.  And *that* is the lawsuit threat that ought to
send the Risk Managers, running down the hall, screaming.  (And surely they
have been consulted about this risk-of-lawsuit business, right?)

Why in heaven's name does anyone think the solution to this scenario is to
stick a bottle of formula in the baby's mouth, and send the family out the
hospital door, never to be seen again?

Does this family need immediate and follow-up referral to a whole slew of
healthcare specialists and social service office?  Yes.  Do the baby and
mother need time-intensive frequent  follow-up care to make sure everything
is going well?  Yes.  Is that easy or cheap?  No.  Is there a possibility
that something will go wrong?  You betcha.

We take our patients as we find them.  It is not up to us -- IBCLCs, RNs,
MDs, custodians, candy-stripers -- to decide whether a patient's life-style
or medical history makes the provision of optimal care an option.

I was spell-bound by a session offered by Metayer and Johnston at the June
2011 AWHONN conference: "Improving Care for Opioid-Dependent Pregnant Women
and Their Newborns," including breastfeeding support in the hospital and
thereafter.  Their program in Vermont is incredible ... they have published
on the topic and I commend to everyone's reading:
https://www.med.uvm.edu/VCHIP/downloads/VCHIP_5%20NEONATAL_GUIDELINES.pdf--

Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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