In a message dated 99-11-19 10:20:32 EST, you write:
<< Hello
My name is Tammy Lawrence. I am a nursing student at the University
of North Dakota. During my rotation in postpartum nursing, I cared for a
breastfed infant who demonstrated possible signs of drug withdrawal that
could not be otherwise explained. This full-term infant had an inconsolable
cry, irritability and uncontrollable tremors; blood glucose levels were
normal. It was questionable whether the mother was using illicit drugs. >>
Tammy, was a urine tox screen done on this mother when she was admitted? Was
it positive for cocaine or other harmful substances? (What does that
"questionable" mean?) Has she been in a treatment program? If so, for how
long? (And does it include good psych assessment and treatment, as illicit
drug use often begins as a form of self-medication for depression, anxiety
disorders, etc.) What is the mother saying about recent/current use? Has
anyone laid it on the line with the mom re: potential side effects for an
infant exposed to cocaine or other such drugs? What is her plan for treatment?
Cocaine use is contraindicated during breastfeeding because it readily passes
into breast milk and cocaine intoxication, with all its awful symptoms, can
occur. This in turn can result in legal action against the mother. (As if the
physical symptoms suffered by the baby are not enough...)
In many areas, mothers abusing drugs that may have such effects via breast
milk are asked to consider breastfeeding only if they meet certain criteria,
e.g. have been off such substance(s) for several weeks to months prior to
giving birth (as demonstrated by negative urine tox screens), have
participated by showing up as scheduled for a treatment program and have
followed treatment recommendations, have a treatment plan with ongoing urine
screening in place, etc.
Good luck with this mom, her baby and your studies.
Karen Kerkhoff Gromada, MSN, RN, IBCLC
Refs:
Auerbach KG (1999). Breastfeeding and maternal medication use. JOGNN, 28(5),
554-563.
Hale TW (1999). Medications and mothers' milk (8th ed.) (p. 171-173).
Amarillo, TX: Pharmasoft Medical Publishing.
Lawrence RA (1997). A review of the medical benefits and contraindications to
breastfeeding in the United States. (Maternal and Child Health Technical
Information Bulletin). Arlington, VA: National Center for Education in
Maternal and Child Health.
Riordan J & Auerbach K (1999). Breastfeeding and human lactation (2nd ed.)
(p. 180-181). Sudbury, MA: Jones & Bartlett.
Wilton JM (1992). Breastfeeding and the chemically dependent woman. NAACOG's
(AWHONN's) Clinical Issues in Perinatal and Women's Health Nursing, 3(4),
667-672.
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