Substance Misuse in Pregnancy - NHS Lothian

Infant feeding
Much confusion surrounds the issue of whether a woman should breast
feed her baby when continuing to take drugs. Many women and their
partners are concerned about breastfeeding whilst taking drugs or
drinking alcohol and will ask for advice. Parents should be informed that
the benefits of breastfeeding far outweigh the disadvantages, even with
continued drug use. It is important to reassure the mother that the actual
amount of most drugs passed to the baby through breast milk is minimal
and will have little effect on the newborn baby (Johnstone 1998). The
sometimes small effect on the baby may even help withdrawal symptoms,
if they are present.
It is important that the woman is not given contradictory advice from
different professionals, as nothing is more certain to reduce her
confidence and to confuse her decision-making.
Breastfeeding
Department of Health (1999) guidance recommends that breastfeeding
should be encouraged in drug-using women. Mothers who are on
prescribed drugs should therefore be encouraged to breast feed in the
same way as other mothers. The exceptions to this would be if she were:
• HIV positive (because of risk of transmission)
• using large quantities of stimulant drugs, such as cocaine, ‘crack’ or
amphetamines (because of vasoconstriction effects)
• drinking heavily (>8 units/day) or taking large amounts of nonprescribed
benzodiazepines (because of sedation effects).
Breastfeeding is best done immediately before taking medication and
should be avoided for one to two hours after any dose of medication (i.e.
the time of highest plasma concentrations). Medications are best taken as
a single dose where possible and should be administered before the baby’s
longest sleep period (SIGN ‘Postnatal Depression’ guideline 2003).
There is no evidence that Hepatitis C transmission occurs through
breastfeeding so mothers who are Hepatitis C positive should be
encouraged to breastfeed (Scottish Executive 2003).
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