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How Drugs And Alcohol Affect Breastfeeding

Debra Wallace, MA.Ed, LPCC-S, LICDC-CS

Medically reviewed by

Debra Wallace, MA.Ed, LPCC-S, LICDC-CS

March 18, 2019

Women who use drugs or alcohol while breastfeeding can be putting their child at risk for several health effects. If you are struggling with addiction, it is important for both you and the health of your child to seek treatment immediately.

Understanding The Risk Of Using And Abusing Substances While Breastfeeding

Before making the decision to breastfeed, a woman should consider and weigh all pertinent aspects of her life, including concerns of substance use, abuse, or addiction. When you use drugs or alcohol, they impact your body in a manner that results in varying amounts of the drug or relating toxins being excreted in your breast milk. Because of this, your child may then ingest certain amounts of these harmful substances. In comparison to adults, infant bodies have a harder time handling the drugs, as certain organs and their metabolisms aren’t even fully developed; older babies are able to process the drugs better, however, the risk is still present.

The danger changes drug to drug and rises fairly proportionately to the frequency and quantity of your use, however, even using a drug once, especially harder, more addictive drugs, presents risks. In the most severe cases, with the most severe drugs of abuse, your child may actually become addicted, experience withdrawal, or even lose their life. Additionally, some drugs like heroin may be cut or laced with even harder, more dangerous drugs, like fentanyl or carfentanil, which hold deadly potential.

In order to better understand the impact and spectrum of damage that may occur, we’ve broken down the risks by several of the most used and abused substances. We also included methadone as a drug of treatment, due to its role within opioid addictions.

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Most Commonly Abuse Substances

Alcohol — The opinion on drinking alcohol while breastfeeding is somewhat mixed. Some think that it is safe to consume moderate amounts of alcohol while breastfeeding. The American Academy of Pediatrics offers that alcohol may be compatible with breastfeeding, but regular or excessive drinking should be avoided.

Alcohol does pass to breast milk, and many experts are firm that no amount within it is considered safe. One scientific review cites that it has been found that moderate amounts of alcohol in the milk lead to “impaired motor development, changes in sleep patterns such as drowsiness or deep sleep, decrease in milk intake and weight gain, and risk of alcohol-induced hypoglycemia.”

What is clear, is that it is not advisable to drink alcohol directly prior to feeding. Various entities recommend that a person feed their child directly before drinking and wait a significant amount of time before breastfeeding after one drinks. This length of time varies per report, but typically it is recommended to wait 2-3 hours per standard drink. Those that have an alcohol addiction are advised not to breastfeed.

Marijuana — Research is more limited on this drug in regards to its short- and long-term effects, however, it is known that THC, the notable chemical within this drug is present in breast milk. Initial findings suggest a person abstain from using it at this time. One study, as reported in the aforementioned review, found that a child encountering THC within their first month via breastfeeding may experience a reduction in motor development at the one-year mark. The publication also noted that “sedation, lethargy, weakness and poor feeding habits” have been connected to THC derived from breast milk.

Cocaine — One journal publication spoke of this drug’s risk, noting that “Sporadic adverse effects, including seizures, hypertension, tachycardia, agitation, and irritability, have been reported in infants after exposure to cocaine by ingestion…by ingestion via breast milk.” Other reports note that it has been found in high concentrations in breast milk to the extent of intoxication in the infant. It is suggested to avoid this drug completely.

Amphetamines/Methamphetamine — Many publications on these note that the nature of these drugs can make it hard for a woman to take care of her baby. These drugs pass more freely into milk than others. The earlier review we mentioned cites reports of “drug-induced behavioral [sic] abnormalities, such as irritability, poor sleeping pattern, agitation and crying.” In addition, though the conclusion was questioned by some experts, there has been one infant death reported in connection to methylamphetamine.

Heroin — ScienceDaily reports that amounts of heroin may be passed into the breast milk in quantities that could cause addiction. The American Academy of Pediatrics cautions that babies may develop restlessness, tremors, vomiting, and even have difficulty feeding. In some cases, a child could potentially die. Some of these risks may be present for some other types of opiates, including death.

Methadone — The Academy of Breastfeeding Medicine writes that “In contrast to other substances…the concentrations of methadone found in human milk are low; therefore women stable on methadone maintenance should be permitted to breastfeed if desired, irrespective of maternal methadone dose. There are no apparent short-term or long-term effects of methadone in human milk on neurodevelopment.” They continue to say that for those babies born from a mother that compulsively used opiates while pregnant, “methadone-exposed infants may benefit from breastfeeding and/or breast milk [sic],” and that breastfeeding can decrease the severity of neonatal abstinence syndrome (NAS).

You May Face Legal Repercussions

Some hospitals have measures in place, should they realize that you insist on breastfeeding with a recent positive urine toxicology screen. In an example, they may then inform social workers, who then contact a Social Services Agency. Also, if they think the newborn is in danger, the doctor in charge may separate the child from the mother. These procedures may vary from hospital to hospital. There have also been numerous news reports of mothers having been sentenced to prison or charged with murder because of drugs such as heroin or other narcotics within breast milk causing their child’s death.

Supporting Women In Evaluating These Risks

With a growing body of research on the subject, medical professionals are learning more and more how to handle and advise situations where substance abuse and breastfeeding may be a cause for concern. One resource, “Guidelines for Breastfeeding and the Drug-Dependent Woman,” has helped to better establish a protocol to help providers assist women in determining if, and how they should breastfeed in regards to their concerns. The following are just a few examples from a more complete list provided within the guidelines:

In an example, the doctors are encouraged to support a woman in breastfeeding if she:

  • Has received prenatal care
  • Will allow her substance abuse provider to contact the obstetrical or pediatric doctors
  • Has substance abuse counselors who can vouch for her sobriety
  • Has been drug-free for 90 days
  • Has a negative urine toxicology-screen, excluding her prescribed medications

Also, a medical team is directed to discourage a woman from breastfeeding who:

  • Has not engaged in prenatal care
  • Will not allow for communication between their substance abuse providers and the obstetrical or pediatric doctors
  • Is not willing to engage in substance abuse treatment
  • Has relapsed within thirty days leading up to delivery
  • Screens positive for illicit drugs at the time of birth

They urge providers to assist by creating a prenatal plan to help women get ready for the demands of being a mother and breastfeeding while constructing a plan for postpartum substance abuse treatment should the need arise or be already present. Within this, they suggest working with a woman on how to prepare and administer formula with a bottle and also detailing the risks should she relapse while she is breastfeeding. On this subject, they do note that if a woman relapses, it is best she is deterred from breastfeeding, “even if milk is discarded during the time period surrounding relapse.”

Concerns Of Taking Prescription Medications During This Time

Though many prescription drugs may be used illicitly, we must include this category for those that have been prescribed these drugs for a medical condition and have used them in the proper manner as prescribed. Fortunately today, technology has progressed to the extent that the medical community is far more aware of the impact certain medications have and the extent in which they’re excreted in breast milk. With this understanding some may be used while you breastfeed, even then, there may yet be minimal risks you should discuss with your doctor.

There may be some instances where a doctor determines that certain medications are necessary. Postpartum depression is an exceedingly common condition that originates due to the vast hormonal changes your body endures during pregnancy and birth, coupled with the changes that these things bring to your life. If this need arises, in you or your partner, please don’t let concerns of medication deter you from seeking help, as in severe cases the effects may inhibit a mother’s ability to fully care for her child. Not all situations warrant medication, however, certain medications are approved for use in nursing mothers.

Generally, if a woman is in close contact with her physician during her pregnancy and during the time after, they will closely monitor medications and make necessary adjustments in the account of breastfeeding.

How To Get Control Over These Substances For You And Your Child’s Health

We understand how difficult substance abuse and addiction can be. An addiction is a disease that actually alters and modifies your brain’s chemistry and the way it functions. Because of this, it can be exceedingly difficult to stop using drugs, even when faced with a pressing concern like breastfeeding. Due to this, if you find yourself or a loved one in this situation, seek help immediately, your child’s life may be at risk.

If you’re using a certain drug or consuming alcohol rarely, you should still seek medical advisement, especially if you’re concerned these behaviors may progress to more frequent use. Should these concerns begin during a period of breastfeeding, whether it be for the first time or relapsing, or if you have been consistently using illicit drugs or abusing alcohol while breastfeeding, we urge you to reevaluate your decision for the well-being and health of your child. In these cases, it is advisable that you stop using drugs in a medically-managed way. You may be directed to wean your child, and it is recommended you speak to your doctor about the formula and bottle-fed options.

Depending on the severity of substance abuse or addiction, your treatment options may vary. For some, an outpatient program may be sufficient. This may be ideal for many women, as it allows them to continue to live at home, remain active in their lives, and take part in their family and parenting responsibilities. For other women who experience more critical concerns, including addiction or dual diagnosis concerns, a hospital setting or inpatient drug rehab may be the best option for you. Some facilities may even allow you to bring your baby with you. With certain drugs, you may need to undergo a medical detox prior to beginning your treatment.

Within a facility that is geared towards helping mothers, staff should be adept at addressing other concerns unique to these women, such as postpartum depression. Family therapy and support may also be a helpful tool within the treatment.

Don’t Endanger Your Child, Seek Help Today

We know how hard it can be to deal with substance abuse or addiction and even to ask for help. Please, for the safety and future of yourself and your child, reach out to us today. can offer you compassionate support to help you find the best treatment options to bring better health to both you and your little one.

ScienceDaily - Breast milk transmits drugs and medicines to the baby

ResearchGate - A comprehensive review of assay methods to determine drugs in breast milk and the safety of breastfeeding when taking drugs

U.S. National Library of Medicine - ABM Clinical Protocol #21: Guidelines for Breastfeeding and the Drug-Dependent Woman

AAP News & Journals Gateway - The Transfer of Drugs and Other Chemicals Into Human Milk

U.S. National Library of Medicine - Maternal cocaine use during breastfeeding

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