According to the AAP, breastfeeding is contraindicated for mothers who
are using drugs of abuse.   This same wording has been used in our own
policy as well. 

However, sometimes it gets fuzzy.  Has anyone else had this experience?
If the mother admits to marijuana (still considered a drug of abuse
legally speaking?) use during pregnancy, do you counsel her not to
breastfeed?  What if she tests positive for percocet, but she tells you
she took it for back pain at the end of pregnancy, even though she can't
produce a prescription or name of prescribing MD.  Do you counsel her
not to breastfeed?  

How about if mom has a negative urine tox screen, but baby has positive
meconium tox screen?  Breastfeeding discouraged?

Does anyone in a hospital setting have a good policy on this?  We have a
clear policy for moms who are on methadone, subutex or suboxone, but
nothing for moms that fall outside of this category.  And even THIS was
confusing when we recently had a mom come in who was using methadone,
but not legally.

And in the end, do we have a right to tell the mom she CAN'T breastfeed?
What are her rights?  If we tell her that we cannot support her
breastfeeding, and she still insists, where do we go from there?  

So, my bottom line question is this:  If there is evidence to suggest
that mom may be using illegal substances (or legal substances obtained
illegally) but she denies such use, and we have notified the social
services, how do we approach breastfeeding for this mom?

Thanks for your help.  Unfortunately these situations are presenting
themselves more frequently each year.

Mary Foley  RN BSN IBCLC
Woburn, MA
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