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