Breastfeed Your Adopted Baby

Yes, you can breastfeed a baby you did not give birth to. In fact, breastfeeding an adopted baby is recommended by the American Academy of Pediatrics. It is even possible to breastfeed if you have never been pregnant or have reached menopause. Although it is different than breastfeeding a baby you were pregnant with, through the process of induced lactation you can breastfeed your adopted baby.

There are several different methods used to induce lactation when you have not been pregnant. It is possible to breastfeed your adopted baby with no preparation at all. However, if you have advance notice that you will have a new baby joining your family, you may wish to explore methods that stimulate milk production before baby arrives. The same methods can be used by traditional adoptive mothers, mothers whose babies were born to surrogates, and even the female partners of birth mothers.

Before learning about the process involved in breastfeeding a baby you did not give birth to, consider why you want to do it in the first place. You may wonder if it is necessary to induce lactation if you have the option of using donor breastmilk. It is important to know that there are differences to bottle feeding breastmilk and breastfeeding directly.

Breastfeeding an adopted baby takes a lot of time and effort but can be very rewarding. If your wish is to produce enough milk to exclusively breastfeed your infant, then you may need to adjust your expectations. Adoptive mothers can make enough milk for their babies, but when they produce this amount is different for every mother. For some it may be in early infancy, and for others it can be after their babies are well on solids, or even after a year. It may not happen right away, but eventually you can expect to get there. While providing breastmilk may be the primary goal for many mothers, the reasons to consider breastfeeding an adopted baby go far beyond the milk itself.

How much milk a mother can produce through induced lactation varies a lot from woman to woman and even baby to baby. There is no way to know ahead of time how much milk you will be able to provide for your baby, especially in the beginning. It is important to keep in mind that even small amounts of your milk, tailor-made for your baby, will be of benefit. Try to keep your focus on the breastfeeding relationship and not just the milk.

The physical connection of breastfeeding benefits both mother and child. The reality is that ALL adoptions involve a loss for the child. Even a newborn infant who is placed right into the loving arms of his adoptive parents is being separated from the only mother he knows:

Adoption universally involves loss. Babies recognize their mothers at birth and at delivery healthy babies placed on the abdomen of their mother will crawl up onto her chest and, locating the nipple via its familiar smell, will attach to her breast and suckle. Newborn infants desire to remain with their mother and if removed from skin-to-skin contact with her will give a specific “separation distress cry/call” as an appeal for reunion. Maternal separation is stressful for infants, and all adopted children have experienced the loss of their birth mother(Gribble, 2006).

Breastfeeding naturally puts you in skin-to-skin contact, which is important to your baby’s development and in forming attachments between you and your baby. Some benefits of skin-to-skin contact for your baby are better organization of reflexes, stable temperature, and regulated heart rate. Some benefits for you include increased milk production, easier breastfeeding, and better oxytocin release (Moore, Anderson & Bergman 2009).

Research has shown breastfeeding to have positive psychological effects for mothers as well. One study compared mothers when they both breastfed and bottle-fed breastmilk to their babies. The researchers found a correlation between breastfeeding and a positive mood immediately after breastfeeding, but the same effect was not apparent for bottle-feeding. The researchers suggested that the higher levels of the hormone oxytocin released by breastfeeding contributed to the positive mood (Mezzacappa and Katkin 2002). Bonding is a crucial aspect of adoption, and the hormones released during breastfeeding can facilitate that process.

Inducing lactation before your baby arrives

When studying the various methods for inducing lactation, keep in mind that it is equally important to learn as much as you can about lactation and how the body is stimulated to make milk by the removal of milk from the breasts. Knowing the natural process of lactation can help you as you work to increase your milk production.

To prepare you can stimulate your breasts by hand or by pump for several weeks or months before your baby arrives. Hand expression requires no equipment and can be used to stimulate milk production.

You may also use a breast pump to stimulate your breasts. It is recommended that you use the highest quality pump available to you when inducing lactation. The first choice would be a rental-grade pump, which you can find in your local area by contacting your birthing facility and asking what rental pumps are available near you and where. These pumps are available for rent through hospitals, medical supply stores, private-practice lactation consultants, online vendors, and even some popular baby stores.

Whether you are using a commercial pump, hand expression, or both, this method is most effective when done as many times a day as a baby would be breastfeeding, 8 to 10 times a day. Combining hand expression and breast massage with pumping has been shown to increase milk production faster(Morton, Hall & Wong, 2009). Many women begin to notice breast changes in the first 6 weeks of expression including breasts that feel larger and firmer, breast tenderness, protruding nipples, and drops of milk.

Another strategy, which can be used in combination with others, requires you to take hormones and/or galactagogues daily to prepare your body for lactation (West, Marasco, 2009). A galactagogue is an herb or prescription medication that increases milk production. One method is called the Goldfarb-Newman Protocol. It involves first taking birth control pills to simulate pregnancy hormone changes and then both expressing and taking medication that increases hormonal levels. Herbal remedies such as fenugreek are available over the counter. You should discuss prescription medications, herbal remedies, and over the counter galactagogues with your health care provider. Variations in treatment may be appropriate according to the needs of an individual patient. All of these substances have potential side effects and may be contraindicated for persons with certain medical conditions. Your health care provider can help you weigh any risks and benefits and decide what will work best in your situation. If you have questions about the safety of medications and herbs while breastfeeding or inducing lactation, contact the InfantRisk Center. The InfantRisk Center is dedicated to providing up-to-date, evidence-based information on the use of medications during pregnancy and breastfeeding.

Inducing lactation after your baby arrives

If you do not prepare before your baby arrives, you can still begin breastfeeding and expressing milk right away. You can also discuss the use of a galactagogue with your health care provider.

Some moms use an at-breast supplementer so that their babies can receive donor milk or formula through a small tube at the breast. There are two main brands available: the Lact-Aid Nursing Trainer and the Medela Supplemental Nursing System (SNS). While both products work by allowing your baby to get supplemental milk while breastfeeding, most adoptive moms report that they prefer the Lact-Aid system because the Lact-Aid does not allow any milk to flow without baby properly latched and sucking at the breast, so it tends to be better for stimulating mother’s breasts. The SNS allows milk to flow by gravity, and there can be a tendency for baby to not latch and suck properly when using it. Many moms also find the Lact-Aid to be more discrete and easier to use away from home. It is worthwhile to do some research on the pros and cons of these products before investing in one.

Lact-Aid

A supplementer has dual benefits: the baby gets nourishment, while mom’s breasts get the stimulation needed to begin producing milk. In fact, some mothers do not use a bottle at all. They find that, if they can get the baby to the breast frequently using an at-breast supplementer and encourage comfort nursing between supplements, they do not need to spend time expressing milk between feedings. Don’t worry about offering your baby a breast with no milk. Keep in mind that babies enjoy comfort suckling and are often offered pacifiers. There is no milk in them, either!

Bringing your baby to the breast

You may be surprised to learn that you can breastfeed a baby of any age, even a toddler. When considering how to get your baby to take the breast and learn to breastfeed, first you need to consider the age and experience of your baby.

If your baby is being carried by a surrogate or in an open adoption where adoptive parents have been matched with the birth mother before birth, you may be able to be at the delivery of your baby and put your baby to the breast immediately. Babies are hard-wired to breastfeed at birth. If you are able to put your baby to the breast right away then the procedures you will follow will be the same as if you had given birth to your baby, like those described in Baby-Led Latch: How to awaken your baby’s breastfeeding instincts.

Even if baby has only had bottles, he may still instinctively root, search for, and take the breast when placed skin-to-skin on his mother’s bare chest. If your baby has a strong preference for bottles, it is still possible to teach him to breastfeed.

When you are working on teaching your baby to take your breast, it is important to be patient and relax. The older your baby is, the more time it may take for him to be comfortable being skin-to-skin with you. A child who has experienced neglect or abuse will need time building trust and attachment before he will be ready to breastfeed (Gribble, 2006). There are many ways to get to know your baby and become comfortable being in the close physical contact required of breastfeeding:

  • Spending lots of time lying down with your baby skin-to-skin
  • Taking baths together
  • Frequently carrying or wearing your baby during the day
  • Sleeping near your baby
  • Holding your baby while bottle feeding
  • Sitting baby on your lap while giving solid foods

Maximizing milk production

Perhaps you have been preparing and inducing lactation for several months, or maybe you started when you met your baby. Either way, the key to establishing breastfeeding with your baby is time together. Research shows that adoptive mothers in developing countries are more successful at producing more milk than mothers in the west. These mothers in developing countries may have higher milk production due to cultural differences that are conducive to breastfeeding such as frequent breastfeeding and remaining in close physical contact with their babies. Their cultures may be more supportive of breastfeeding as well. Emulating the mothering styles of women in developing countries and creating a support network for breastfeeding may help to maximize your milk production (Gribble, 2004).

The more your breasts are stimulated, and the more milk you remove, the more milk your body will produce. Be patient; the first milk you may notice will be a few drops, and the increase is very gradual. Nursing as much as possible is the best way to increase production and decrease the need for supplements.

  • If at all possible, feed only at the breast using an at-breast supplementer.
  • Offer both breasts twice at every feeding, and use breast compressions to maximize the amount of milk removed.
  • Encourage comfort nursing between feedings. Offering the breast without supplemental milk flowing provides more stimulation to your breasts and keeps the baby interested and comfortable with nursing at a breast with less milk flow.
  • If baby is unable or unwilling to nurse without the supplementer, consider expressing milk between feedings.

As you are able to produce more milk, you can decrease the amount of supplemental milk your child is receiving. Counting wet diapers and watching baby’s weight-gain will reassure you that your baby is getting enough. One technique for decreasing supplements that can work well is to start by eliminating supplements in the morning, when milk flow is usually highest. Try not supplementing after the first morning feeding. Each time your baby finishes nursing on one side, offer the other side. Keep offering the other breast until baby seems satisfied or falls asleep. Gradually delay the first supplement later and later. When your baby begins to eat solid foods, let the solids begin to replace supplemental milk, not time at the breast.

Finally, make sure you have built a support system. Consider contacting a La Leche League Leader, Breastfeeding Counselor or International Board Certified Lactation Consultant to work with you. Read as much as you can about adoptive breastfeeding and induced lactation. The resources below will give you a place to start.

Adoptive Breastfeeding Stories
My Adoptive Breastfeeding Story
Breastfeeding My Adopted Child
We Are Breastfeeding
My Adoptive Breastfeeding Journey
Becoming Nana

Additional Resources
Books
Breastfeeding an Adopted Baby and Relactation, by Elizabeth Hormann.
The Breastfeeding Mother’s Guide to Making More Milk, by Diana West and Lisa Marasco.

Websites
Asklenore.com

Four Friends Adoptive Breastfeeding Resource Website

Dr. Jack Newman: Breastfeeding your Adopted Baby or Baby Born by Surrogate

Lact-Aid: Frequently Asked Questions About Nursing Adopted Babies

Lowmilksupply.org

References
Buckley, K. & Charles, G. (2006) Benefits and challenges of transitioning preterm infants to at-breast feedings. International Breastfeeding Journal 1:13

Gribble, K. (2004) The influence of context on the success of adoptive breastfeeding: Developing countries and the west. Breastfeeding Review; 5-13.

Gribble, K. (2006) Mental health, attachment and breastfeeding: implications for adopted children and their mothers. International Breastfeeding Journal 1:5.

Horman, E. (2006) Breastfeeding an Adopted Baby and Relactation. Schaumburg, IL: La Leche League International.

Induced Lactation and the Newman-Goldfarb Protocols for Induced Lactation

International Breastfeeding Centre. Breastfeeding Your Adopted Baby or Baby Born by Surrogate/Gestational Carrier

Mezzacappa, E. S., and E. S. Katkin. (2002). Breastfeeding is associated with reduced perceived stress and negative mood in mothers. Health Psychology 21:187-193.

Moore ER, Anderson GC, Bergman N. (2009) Early skin-to-skin contact for mothers and their healthy newborn infants Cochrane Summaries

Morton J, Hall, J and Wong, R et. al. (2009, July, 2) Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology advance online publication; doi: 10.1038/jp.2009.87

West, D. and Marasco, L. (2009) The Breastfeeding Mother’s Guide to Making More Milk. McGraw-Hill.

 

© 2012 Teglene Ryan

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Rapid Weaning for Emergency Situations

Emergency Weaning

Weaning in a rush most often means that you probably have not had much time to prepare emotionally for the separation. It can be a highly charged time filled with a sense of loss, and even anger at the situation that is causing the weaning.
You may have found this page because there is acute medical necessity to wean: cancer treatment that requires chemotherapy, an HIV positive diagnosis in the USA, addiction to prescription pain medications or street drugs, or complex medical treatment involving medications that transfer into breastmilk at unsafe levels (without safer substitutions for the doctor to prescribe). You may also be reading because your baby had died, or you have lost a pregnancy after about 16 weeks. In these situations you must often choose a difficult weaning process that is entirely mother-led and it may occur far before you (or your baby) is ready. There isn’t time for gradual tapering of nursing sessions, because you are counseled to immediately wean.

Herbs and Medications That May Be Helpful in Reducing Milk Production

There is significant data that some medications and herbs reduce a mother’s milk supply. Among the herbs commonly used to “dry up” a mother’s milk are:

  • Peppermint  You can make a strong saturated tea and drink throughout the day. Some mothers have said that eating Altoids (a strong mint candy that contains significant amount of peppermint oil) throughout the day can aid in stopping milk production.
  • Sage You can make the leaves into a tea, or add this herb as a fragrant addition to foods. Concentrated amounts of sage (such as in tinctures and teas) may not be safe for use during pregnancy. Please consult your physician, herbalist, or traditional healer for more information.
  •  Jasmine flowers Crushed, and used as a poultice placed on the breast (Shrivastav 1988)
  • Cabbage leaves  Chilled, and used as a cooling compress placed directly onto the breast. (Use as frequently as needed for discomfort, change leaves when wilted)

Medications that have been reported to suppress lactation may be discussed with your health care provider, but should never be taken without the guidance of a healthcare professional due to risk of side effects or medical complications. Care should be used if you think you are pregnant, and you should discuss your options over with your doctor or midwife. The following types of medications have been reported to suppress breastmilk production in mothers:

Breast Engorgement

When a mother is breastfeeding her baby, milk is removed regularly and breastmilk production continues at a fast rate until the breast is full. If a mother suddenly stops nursing, her breasts will fill with milk and cause engorgement. Engorgement is usually very uncomfortable, it can make the breasts feel hot, hard, or heavy, and it is frequently reported to be a cause of pain and tenderness.

Having full breasts sends a message to the breast to stop producing milk; a full breast is necessary for milk production to slow down and stop quickly. Binding the breasts is not recommended in women trying to wean fast, and may cause health complications such as blocked ducts or mastitis. Consider wearing a supportive, non-binding bra, use a cool compress, and avoid heating pads, or things that increase the temperature of the breast.

Some mothers have reported that expressing (removing) some of their milk so that they are not painfully engorged is helpful. Removing just a little milk often reduces the discomfort from feeling too full, and it can help a mom avoid feeling really uncomfortable. With milk expression, the goal is to remove just to comfort, do not drain your breast! Remember: If you are weaning due to current drug or medication use, take to your health care provider before feeding your baby with any of your expressed milk.

Quick Comfort Measures

Cold packs, frozen peas, frozen cabbage leaf compresses, and other cool compresses on the breasts will most likely help with engorgement pain. You can remove a little milk for comfort, but do not drain the breast. You can also check to see if taking an over the counter anti-inflammatory medication is acceptable with your health care provider.

Problems with Engorgement

Occasionally some mothers experience blocked ducts or mastitis when they have been engorged for a long time. If you develop a fever over 100 degrees, your breasts are painful, you see red streaking on your breasts, or you feel a large wedge shape area that is hot to the touch, please contact your healthcare provider immediately for health counseling.

How to Feed Your Baby After Weaning

Find a bottle nipple that your baby will accept: the slower flow nipples will be an appropriate transitional speed of milk delivery, if you have been breastfeeding up until now.

If your baby refuses a bottle, consider offering cups, slow flow sippy-cups, offering milk at different temperatures or spoon feeding.

What to Feed Your Baby After Weaning

If you are eligible to receive human milk from a milk bank you will be able to offer donor breastmilk . If you have stored milk from a period of time when your milk was medication/drug-free you can use that too. If the baby is under a year old, it is recommended that you do not offer cow’s milk or other animal milks in place of human donor milk or artificial baby milk (formula). Cows milk and other animal milks do not provide the proper nutrition for an infant. Take to your healthcare provider for personalized information and recommendations regarding feeding options.

A Mother’s Feelings about Weaning

The physical sensation of very full breasts and being unable to nurse your baby or child may be very difficult. Not being able to respond in the normal fashion to your baby’s need to nurse, cuddle at your breast, or dealing with your own emotional need to connect to your child may be the hardest part of weaning quickly. As an adult you understand why weaning is happening, but a young child will most likely not understand and you will probably need the support of family or friends during this challenging time for both of you.

It is normal to feel sad, anxious, worried, to cry, to feel angry at your situation, and to feel sorrow at not being able to communicate the reasons for not breastfeeding in an understandable way with your baby/toddler. Finding another mother to speak with may be a very good way to talk through your feelings. If you are unable or unwilling to discuss the topic of your weaning with others, there are community support programs that offer free counseling to mothers in crisis. If your depression feels very strong, you are crying frequently, or you start to feel like hurting yourself or your child, please call 1-800-273-TALK or Chat http://www.suicidepreventionlifeline.org/.

There should be no shame in reaching out for help when you need it.

Moving Into a New Phase Of Mothering

As part of the cycle of life, mothers carry their unborn children, birth them, guide them and love them in childhood and beyond. It is part of a normal process for all animals to wean in their own time. For some mothers the grieving of a lost relationship must happen before any forward motion can happen. Allowing yourself time to sit with your feelings, without trying to bury them, may help you gather the strength to begin your new role as a mother that is not nursing.

The bond that is forged by breastfeeding is a strong bond. I have described it as an invisible cord that connects the two hearts of the mother and the child. If there is separation, the cord stretches easily, but it remains connected.

Once you have made it through the initial period of weaning, your child may still protest the loss of nursing. It is very common and normal for a baby or toddler to reconnect with their mother by sticking an arm down mom’s shirt, or by touching the breast for reassurance.

It may be hard to do without breastfeeding, but with time and patience you will restore your positive and healthy relationship with your child. By normalizing your experience, telling your child why things are happening in simple ways (even if they cannot understand much language yet) they will most likely feel respected and included. I do believe that all weaning, even rapid weaning can be done with compassion.

As an end note, mothers who have weaned may resume breastfeeding. If weaning is only necessary for a short period of time while you’re undergoing treatment, it may be possible to maintain your production in order to resume breastfeeding at a later time. You can read an article on that topic here: Can There Be Breastfeeding After Weaning

References:

Aljazaf, Khalidah et al. Pseudoephedrine: effects on milk production in women and estimation of infant exposure via breastmilk. Br J Clin Pharmacol. 2003 July; 56(1): 18–24 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884328/

Dettwyler, K., Ph.D. (1999). A Natural Age of Weaning. Retrieved April 21, 2012, from Katherine Dettwyler website: http://www.kathydettwyler.org/detwean.html

Riordan, J., & Wambach, K. (2010). Lactation Following Breast cancer. In Breastfeeding and Human Lactation (4th ed., pp. 316-317, 606). Mississauga, Ontario Canada: Jonesand Bartlet.

Shrivastav P, George K, Balasubramaniam N, Jasper MP, Thomas M, Kanagasabhapathy AS. Suppression of puerperal lactation using jasmine flowers (Jasminum sambac). Aust N Z J Obstet Gynaecol. 1988 Feb;28(1):68-71.

Thomson Healthcare Inc.  Bromocriptine (oral route).  2012. Micromedex, Mayo Foundation for Medical Education and Research.

(c) 2012 Serena Meyer, IBCLC. All rights reserved. Updated 10/14

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¿Por qué siento tanto sueño cuando amamanto?

Muchas madres luchan por mantenerse alertas mientras amamantan, especialmente durante la noche. Parte del cansancio asociado a la maternidad puede ser atribuido al sueño interrumpido; sin embargo, hay más en esto que falta de sueño. Aun cuando la madre no esté particularmente cansada puede sentirse adormilada mientras amamanta durante el día. Cuando su bebé se queda dormido, la madre puede sentir ganas de dormir una siesta junto a él.

Existe en el cuerpo humano una hormona gastrointestinal llamada colecistoquinina (CCK), y una de sus funciones es la de dar una señal de sedación y de saciedad y bienestar después de comer. Durante el amamantamiento tanto la madre como el bebé producen CCK y esto provoca una sensación de somnoliencia y satisfacción. La hormona prolactina, llamada a veces “la hormona maternal”, también tiene un papel en que las madres se sientan relajadas durante la lactancia. La CCK liberada y el pico de prolactina que se produce en las madres se combinan en un cocktail adormecedor, difícil de resistir.

Un artículo de Liga de La Leche sobre la composición de la leche humana ( Myer 2006) afirma:

“El nivel de CCK en el bebé presenta dos picos después de tomar el pecho. El primer pico aparece inmediatamente después de la toma. Vuelve a presentar un pico 30 a 60 minutos más tarde. El primer aumento de CCK se debe probablemente a la succión al pecho; el segundo a la presencia de leche en el tracto gastrointestinal. La caída de CCK en el bebé 10 minutos después de la toma resulta en una “ventana” dentro de la cual el bebé puede ser despertado para alimentarse del segundo pecho o para retomar el primero y tomar así leche rica en grasas. Esperar 30 minutos antes de recostar al bebé luego de una toma permite aprovechar el segundo pico de CCK que ayuda a que el bebé se mantenga dormido.”

Junto con un vínculo psicológico significativo que hace que las madres estén “sintonizadas” con sus bebés, hay también conexiones químicas entre la madre y su bebé. Un tipo de comunicación física genera otro, y el niño y la madre están conectados a un nivel muy profundo y personal a través del acto de amamantar y de la leche en sí. Un estudio publicado por (Kierson et al., 2006) demostró que la leche contiene hormona ghrelina y no CCK . La ghrelina aumenta el apetito y promueve el almacenamiento de grasa abdominal, importante para los niños pequeños en etapa de crecimiento. La CCK que circula en la madre no es compartida con el bebé; el bebé produce su propia CCK. Los autores dedujeron que la ghrelina era producida y excretada por el pecho porque los niveles de ghrelina en la leche eran mayores que los plasmáticos. Aparentemente la glándula mamaria produce un mensaje de ghrelina que es transmitido al bebé.

Es difícil identificar por qué la madre segrega CCK durante el amamantamiento. Las publicaciones muestran que la evidencia disponible no se enfoca sobre esa cuestión. Podemos, sin embargo, analizar las razones posibles detrás de una necesidad biológica de la madre de sentirse satisfecha, adormilada y relajada durante el amamantamiento. ¡Se dormiría y estaría disponible para amamantar más en 30 minutos? ¿Se libera CCK para promover armonía, placer o vínculo? ¿Qué tipos de realimentación hormonal hacen que las madres sientan la lactancia como algo deseable?

Bibliografía:

Basque Research. (2009, 2012 web), Action of ghrelin hormone increases appetite and favors accumulation of abdominal fat. ScienceDaily, http://www.sciencedaily.com/releases/2009/05/090520055519.htm

Keirson, Jennifer A., et al. (2006, 2012 web), Ghrelin and cholecystokinin in term and preterm human breast milk. Acta paediatrica, 95: 8, 991-995. http://cat.inist.fr/?aModele=afficheN&cpsidt=17997348

Myer, S. (2006, 2012 web), What makes human milk special? La Leche League International, NEW BEGINNINGS, 23: 82-83. http://www.llli.org/nb/nbmarapr06p82.html

Nagin, M. K. (2009, 2012 web), Prolactin. About.com, http://breastfeeding.about.com/od/breastfeedingbasics/g/prolactin.htm

(c) 2010 Serena Meyer, IBCLC All Rights Reserved
updated 7/16/2012

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Returning to Work: The Breastfeeding Mother’s Guide

Returning to work after giving birth can be stressful for many mothers and their families. It is often hard to adjust to being both a mother and an employee, and you may have mixed feelings about leaving your baby.  Mothers often report that they are sad to leave their children, and it is normal to feel hesitant or reluctant to part with the small person who holds a lion’s share of your heart. Both new and veteran parents worry about childcare for their new infants. You may be wondering how your baby should be fed when you are away and how milk you should leave at daycare. This article will address some common questions breastfeeding mothers have about continuing to breastfeed and providing breastmilk for their babies after returning to work or school.

How much milk will my baby need while I’m away?

Breastfed babies need, on average, 24 to 32 ounces of milk per day (Kent et al., 2006). If you spread that amount over a full day it equals 1-1.25 ounces per hour. With that information in mind, plan on leaving about 1-1.25 ounces of milk for each hour of separation. Most breastfed babies need no more than 2-4 ounces at each feeding (Kent et al., 2006). Breastfed babies need less milk than formula-fed babies do, and unlike with formula, the amount of breastmilk your baby needs does not increase as he grows bigger. When you return to work, your baby will need only a portion of this daily amount of milk from the care provider, because he will still be getting much of it by breastfeeding during the hours of the day and night when you are together.

Offering smaller bottles, of no more than 2-4 ounces, means there is a smaller chance that your baby will not finish his bottle and leave milk that must be thrown away by licensed daycares.

How many times do I need to express milk at work?

How many times you pump at work will depend on a few factors: how long you are away from baby, how well you respond to milk-expression, and your work situation. Many working moms plan to pump milk at least as often as every 3 hours. If you are becoming engorged between pumping times, you may need to remove milk more frequently. Every mother has her own “magic number” and will differ in how frequently she needs to express her milk to both maintain milk production and provide enough expressed milk for her baby.

Try to remove milk as often as it takes to collect enough for your next work day.

What if I can’t stop to pump as frequently as I would like?

When it is challenging to find enough time to pump your milk, here are some time-saving options:

  • Breastmilk can be kept at room temperature for 6-8 hours (ABM, 2004). With this guideline in mind, you do not need to take time to wash out your pump parts after every use. Keep your pump parts and bottles of milk in a cool place, and cover them with a cool towel; a small cooler or insulated lunch pack is another option.
  • Some mothers place all of their pump parts in the refrigerator along with their bottles of expressed milk each time they pump. At the end of the day, they take all of the parts home to wash.
  • Consider arranging your schedule so that you can arrive at work 15 minutes before you need to “clock in” and pump before you start work.
  • If you don’t have enough time to completely drain your breasts, it is still valuable to stop and express some milk, even if it you only have 5 minutes.
  • If expressing in your car could help you save some time, consider purchasing a car adapter for your pump and a hands-free pumping bra (or you can make your own) so that you can pump with your hands free. For your safety, we recommend that you do not express milk while driving.
  • If you are mobile during your work hours, a cooler for your milk will help preserve your milk at a lower temperature, and you can save time by expressing milk whenever you have an opportunity.

How should I store the milk I pump at work? Do I put it all in the freezer?

In order for your baby to get the most anti-infective properties from your milk, it is best to offer it fresh whenever possible. Freezing has been found to denature some of the antibodies and kill some of the living cells in milk (Orlando, 2006; Buckley & Charles, 2006). Whether fresh or frozen, your milk provides all the nutrition your baby needs, and you can count on your milk to support your baby in all areas of growth and development.

Here is a schedule many working mothers recommend for using frozen milk. With this system, your baby gets more fresh milk and therefore the best possible nutrition and immune factors to protect him from illness:

  • Pump on Monday; give this milk to your babysitter to use on Tuesday.
  • Pump on Tuesday; use this milk on Wednesday and so on until Friday.
  • Pump on Friday, label with the date, and freeze this milk; put it in the back of the freezer.
  • Use the oldest milk in the freezer for Monday.
  • Use your freezer stash only when you have an unusual need for extra milk, for example, when your baby is going through a growth spurt or you accidentally spill all of your freshly-pumped milk.

This system prevents the frozen milk from getting too old and needing to be thrown out. Another option would be to refrigerate Friday’s milk over the weekend and let your babysitter use it on Monday. This practice would preserve more of the antibodies in Friday’s milk but would not use up your frozen milk before it goes out of date.

What if my baby’s caregiver says my baby needs more milk?

With bottle-feeding, there can be a tendency for the person feeding to encourage the baby to finish the bottle. Milk flows easily from a bottle nipple, even when the baby is not actively sucking, and the faster flow can cause a baby to continue feeding after he is full. Caregivers may believe that a baby needs more milk than he actually does, and many childcare workers are accustomed to the larger amounts of formula they feed many babies. Make sure that your caregiver has the correct information about how much breastmilk a baby needs and understands the difference between bottle-feeding breastmilk and formula.

You can offer some tips to your baby’s caregiver on how to bottle feed in a way that supports breastfeeding:

  • Use a slow-flow soft bottle nipple that has a wide base and a shorter, round nipple (not the flatter, orthodontic kind).
  • Start by resting the tip of the nipple on the baby’s upper lip and allow him to take it into his mouth himself, as if he were nursing.
  • Keep the bottle only slightly tilted, with the baby in a more upright position, so he has to work to get the milk out. If you hold the bottle straight up, the milk will come out too fast, and he may feel overwhelmed by the flow (Kassing, 2002).

If your baby is refusing bottles, or you prefer not to use one, there are other options available:

  • You can try cup or spoon feeding. If you use either a cup or spoon, make sure your baby is fed while sitting in an upright position and that the feeding is “paced” (slow).
  • If your baby continues to avoid any type of feeding while you are away, despite offering your milk from a spoon or cup, you may want to investigate slow-flow sippy cups (avoid ones that encourage babies to bite the tip to get milk).
  • Some mothers have said that offering frozen milk in a mesh feeder worked for them; babies may respond favorably to the new texture and temperature of the milk.
  • Investigate whether you can have your baby brought to you by your care-provider during a break so that you can nurse.
  • Another option, when your baby is refusing expressed milk, is offering to make up missed feedings when you are together. This is often called reverse cycling.
  • If your baby is over 6 months, and ready for solids, you can send foods for him that have a higher content of water such as melon. Your baby will ideally be able to get an amount of your milk in some way, but there are other ways to cope with hydration issues if your baby is unwilling to take your milk in a liquid form.

What if I’m not expressing enough milk?

Here are some tips to increase the amount of milk you are expressing:

  • Go back to the basics of learning how to express your milk.
  • Relax. Take a few deep breaths and get comfortable before you begin expressing your milk.
  • Avoid watching the bottles to see how much milk is coming out. Instead, focus on your baby, listen to music, or try some relaxation methods. Many mothers find that watching how much milk is coming out reduces the amount they are able to express. Try covering the bottles with a cloth or towel, so they are not visible. There is evidence that music can be soothing to mothers while they are pumping and improve milk-removal. Music-based practices have been shown to encourage better milk production in mothers who have babies in the nicu (Keith, D.R. et al., 2012).
  • Add another breastfeeding session, especially if your baby is sleeping 5 or more hours in a row at night.
  • If you are unable to express more frequently at work, another option is to express milk at home first thing in the morning.
  • Try more frequent, shorter sessions of expressing milk. Many mothers have said that several 20-minute sessions will yield more total milk than a couple of 30 minute sessions.
  • Send what you are able to express. Nurse at drop-off and pick-up to decrease the total amount of milk needed while you are separated. Remember that your baby has 24 hours in the day to get all of the milk he needs. If he does not get enough in the time you are apart, he can nurse more when you are together in order to get the total amount he needs.
  • If you are using a pump, check its condition. Some pumps need parts replaced frequently to maintain full suction.
  • Rule out any health-related complications to milk production with your health-care team; there are many reasons that mothers experience a dip in supply.
  • Try “hands on pumping” when you are expressing milk to empty the breast.
  • Use some gentle massage before you express: starting in the armpit and work toward the nipple in gentle, circular motions.
  • Update the pictures of your baby that you are using when you are expressing. Bring some worn baby pajamas and try smelling them to help you mentally bring your baby into the room with you. Some mothers have said that recordings of their babies are also helpful. One mother reports that creating a sound file of her baby’s sounds and favorite lullabies together was most effective for her.

If you need more information about returning to work or expressing your milk, a Breastfeeding USA Counselor, La Leche League Leader, Nursing Mother’s Counsel or International Board Certified Lactation Consultant may be able to help. Accessing a community support system can help you reach your breastfeeding goals. You are also welcome to contact us directly for more support or information.

You may also be interested in these articles:
Preparing for Your Return to Work: The Breastfeeding Mother’s Guide
Baby-Led Bottle Feeding
Breast versus Bottle: How Much Should Baby Take?
Facts Every Employed Breastfeeding Mother Needs to Know

References

Academy of Breastfeeding Medicine. (2004). Clinical Protocol Number #8: Human Milk Storage Information for Home Use for Healthy Full Term Infants  [PDF-125k]. Princeton Junction, New Jersey: Academy of Breastfeeding Medicine.

Buckley, K. Charles, G. (2006).  Benefits and challenges of transitioning preterm infants to at-breast feedings. International Breastfeeding Journal, 1,13

Kassing, D. (2002). Bottle-feeding as a tool to reinforce breastfeeding. Journal of Human Lactation, 18(1),56-60

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.

Orlando, S. (2006). The immunologic significance of breast milk. J Obstet Gynecol Neonatal Nurs, 24(7), 678-83

Mellentine, K. (2003). Converting a Regular Bra into a Pumping Bra. Jan Andrea, at home on the web. Website: http://www.sleepingbaby.net/jan/Baby/pumping_braconvert.html

Stuebe, A. (2011). Podcasts for Breastfeeding. itunes. Apple, Inc. Website:
http://itunes.apple.com/us/podcast/podcasts-for-breastfeeding/id432087823#

Keith, D.R., Weaver, B. & Vogel, R. (2012). The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants. Advances in Neonatal Care, 12(2):112-9. http://www.ncbi.nlm.nih.gov/pubmed/22469966

Callahan, A. (2012). Pump Up the Music: Improving Breast Milk Production in the NICU. Website: http://scienceofmom.com/2012/04/12/pump-up-the-music-improving-breast-milk-production-in-the-nicu/

© 2015 Serena Meyer RN, IBCLC and Teglene Ryan, IBCLC

Posted in Articles for Breastfeeding Support Workers, Breastfeeding, Resources for Parents | Tagged , , , , , , , , , | 1 Comment

Preparing for Your Return to Work: The Breastfeeding Mother’s Guide

When a family is expecting a baby, it’s a time full of wonder and happy expectation. For months, a mother feels fluttering and quickening, the soft movements of her baby. For many families, it is also a time for making plans to welcome a new family member. Parents may also use the time of pregnancy or the waiting period for adoption to investigate how to support the breastfeeding relationship in the workplace or in school. This article addresses some common questions breastfeeding mothers have about preparing for a return to work and includes the concerns that mothers who do not have a pro-breastfeeding workplace or school may face.

Talk to your employer

This article, Pumping 9 to 5, provides some information on how to talk to your employer about breastfeeding and how to make a plan for expressing your milk at work. Being ready for this conversation, with an idea of what you will need in terms of space and time, will help make your points clear and concise. Take the time you need to make a plan before you speak with anyone at your school or job. Other workplaces, tribes, and many places of higher education have set up lactation rooms; think about bringing them up in your conversation to support your requests. It may also be important to mention the ways your workplace or school will benefit from setting up a lactation room for other families. This booklet explains some of the possible concerns that a business or institution may have about setting up a lactation program for individuals that either work in or attend the facility.

Know your rights

There are State and Federal Laws in place to support breastfeeding mothers. For example California Labor Code 1030-1033  stipulates:

Every employer, including the state and any political subdivision, shall provide a reasonable amount of break time to accommodate an employee desiring to express breast milk for the employee’s infant child. The break time shall, if possible, run concurrently with any break time already provided to the employee.

Additionally, the IHS and many Government agencies provide pumping breaks for their employees, and many institutions already have supportive programs in place for breastfeeding mothers. The Affordable Care Act of 2010, states that:

Effective March 23, 2010, the Patient Protection and Affordable Care Act amended the FLSA to require employers to provide a nursing mother reasonable break time to express breast milk after the birth of her child. The amendment also requires that employers provide a place for an employee to express breast milk.

Consider all of your options

Are you able to change your work schedule or delay returning to work or school? Some mothers have worked out job shares or found other ways to minimize separation from their babies. Talk to your employer about what might work for you.

  • Some companies offer on-site day-care or allow a mother to bring her baby to work with her so that she may continue to breastfeed. This arrangement eliminates the need to express milk because the mother can breastfeed her baby throughout the work day. Plan ahead: many on-site day-care facilities have long waiting lists.
  • Working from home part or full time is an option in some situations.
  • If you are not able to bring your baby with you or visit him during the day, consider a day-care situation that would allow a care-provider to bring him to you.
  • Split the work week with a co-worker who is looking for extra hours or a partial shift.

When should I start expressing milk?

Babies grow so fast! They are newborns for only a few weeks, and before you know it, they are smiling, cooing, and reaching for your face while you are nursing. In the first several weeks after birth, take all the time you can to relax, get to know your baby, and just enjoy being his mom. Unless you have to return to work right away, it is recommended that mothers wait until breastfeeding is well-established before they begin expressing milk for returning to work: for most mothers, somewhere between 3-4 weeks. If you have to return to work earlier than 4-6 weeks, you might wish to begin pumping milk two weeks before you plan to return to work.

Learn how to express your milk

Preparing for your return to work or school can begin with learning to express your milk.

  • You can express milk by hand, with a breast pump, or by using a combination of the two.
  • Learning how to remove milk without your baby requires both developing your own expression technique and conditioning your milk ejection reflex (MER) or “let down” to respond to it.
  • Most mothers experience MER in response to the sensation of their babies suckling as well as other stimuli like the sound of a baby crying. If you are having trouble eliciting MER during expression, try visualizing your baby at the breast or listening to a recording of your baby’s cry. Looking at pictures of your baby or smelling your baby’s clothes or a blanket may also be helpful. If you have a video feature on your phone, try recording your baby breastfeeding so you can play it back while expressing. One study indicated that mothers who replicated their babies’ sucking patterns by adjusting the cycle settings on their pumps expressed more milk (Meier, et al, 2012).
  • Warming the breast before expressing and gentle breast massage (working from the armpit towards the nipple with a soft kneading touch or in a circular motion with flat fingers) has been effective at increasing the amounts of milk removed during expression (Jones, Dimmock & Spencer, 2001).
  • Combining hand expression and massage with a pumping routine has been shown to assist with increasing milk production and output (Morton, Hall & Wong, 2009).

How do I hand express?

Hand expression requires no special equipment and can be an effective way for you to remove milk when separated from your baby. Some mothers find that hand expression is more effective for them than pumping because it is more comfortable, and they can feel for areas of fullness and apply pressure with their fingers exactly where it is needed. Once you have success with a method of hand expression, you may feel that you are able to meet your baby’s needs without a pump.

What type of pump should I use?

A high-quality, full-size, double-electric pump is recommended for a mom who plans to pump milk every day. A pump that is made by a manufacturer specializing in breastfeeding equipment will be of higher quality than cheaper pumps made by a company whose primary products are bottle-feeding equipment or baby food. A breast pump is an item for which the old adage, “You get what you pay for,” often rings true. Another option for many mothers is renting a multiple-user pump from a trusted source such as a Hospital, Tribal Health Clinic, or local IBCLC. Most WIC offices provide pumps to moms who are returning to work or school; contact your local WIC office to see if you qualify. Many families have health insurance that is willing to cover the cost of renting a hospital-grade pump. If you are able, call your insurance provider for the details of your own coverage when you are pregnant. Recent 2011 news from the IRS states that electric pumps are now tax deductible, so keep your receipts for your tax records.

In our opinion, the top three single user pumps on the market today are:

Pump Brand/Model Cost range Warranty Mechanics WHO-CODE
Hygeia Enjoye* $180-300 3 year Closed system Compliant
Ameda Purely Yours $150-180 1 year Closed system Compliant
Medela Pump in Style $250-350 1 year Open system Non-compliant

*Sold in the category commonly referred to as single-user pumps; Hygeia is the only pump company that has sought and received FDA approval for their pump to be used by more than one person.

What is the difference between an open and closed system pump?

  • With an open system, if milk or condensation makes its way into the tubing, it is possible for mold to begin to grow in the motor. There is no way to clean the pump motor, and any mold spores present could come through the tubing and possibly into contact with the expressed milk. Furthermore, if the pump is second-hand or was used by another mother, germs from one mother or her milk could contaminate the milk in the same way. An open system is built to be a single-user system only.
  • Closed system pumps are just what they seem: there is no way for the milk to come into contact with the motor. Theoretically, any closed system pump could be safely used by more than one person (each with her own tubing and other external pump parts).

What is the WHO CODE, and why is it important to consider when buying a breast pump?

The “WHO CODE” is short for the World Health Organization’s International Code of the Marketing of Breastmilk Substitutes. Part of the purpose of the WHO CODE is to protect breastfeeding by preventing aggressive marketing of breastmilk substitutes and artificial nipples. Many people prefer to purchase a breast pump from a company that is supportive of and compliant with the WHO CODE.

More information on both the breast pumps, the WHO CODE, and open and closed systems can be found at: The Problems with Medela

How often should I express milk?

Once a day is usually plenty at the beginning. Most moms find that they are able to express the most milk in the morning hours. You can nurse your baby on one side while expressing milk on the other side. Or you could pump both sides about one hour after your baby’s first morning feeding. Don’t worry if you don’t get very much milk at first. It takes practice, and your body needs to “learn” to make milk for that extra “feeding.”  When milk is removed, your body responds by making more milk at a faster rate.  It can take a few days for your body to increase production (Daly, Kent, Owens et al.,1996). Any milk collected during these practice sessions can be stored in the freezer.

How much milk should I have stored in my freezer?

Many mothers find that they feel less stress if they to know that they don’t need to create a large freezer stash of milk before they return to work. Instead, they can use their maternity leave to focus on being with their babies and getting breastfeeding well-established. If you have enough milk to send with your baby on your first day, then you have enough in the freezer.

It is important to express as much milk while you are at work as your baby needs during that time. If your baby needs 10 ounces while you are away at work, then you need to pump at least 10 ounces each day.
For example:
If you were to only pump 8 ounces and send 2 ounces from the freezer each day, you would not be expressing the amount of milk your baby requires. Your body will “think” that your baby needs 2 fewer ounces each day than he really does, and your production will not match his demand. If you start to run out of milk in your freezer, you may face the difficult decision of how to meet your baby’s needs. Many mothers learn too late that increasing their milk supply to meet their baby’s demands is more complex than it seems. Meeting your child’s daily needs for expressed milk during separation is the best way to avoid difficulties later.

Using the simple system described, you pump each day what your baby would need the next day. This way you only use the small freezer stash for emergencies, such as dropping and spilling a day’s worth of milk, or other milk-related calamities.

If you need information about returning to work or expressing your milk, a Breastfeeding USA Counselor , La Leche League Leader, Nursing Mother’s Counsel or International Board Certified Lactation Consultant  may be able to help. Accessing a community support system can help you reach your breastfeeding goals. You are also welcome to contact us directly for additional information or support.

You may also be interested in these articles:
Returning to Work: The Breastfeeding Mother’s Guide
Are There Differences Between Breastfeeding Directly and Bottle-Feeding Expressed Milk?
Breast versus Bottle: How Much Should Baby Take?
Facts Every Employed Breastfeeding Mother Needs to Know
I’m Worried My Milk supply is Drying Up, What Can I Do?

References

Black Bear, J. (2011). Breastmilk Storage and Handling Guidelines. http://nativemothering.com/2011/04/breastmilk-storage-guidelines/

Daly, S., Kent, J., Owens, R. & Hartmann, P. (1996). Frequency and degree of milk removal and the short-term control of human milk synthesis. Exp Physiol, 81(5), 861-75.

Easy Steps to Supporting Breastfeeding Employees. (2008). U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau. Produced in contract with Every Mother, Inc. and Rich Winter Design and Multimedia. http://mchb.hrsa.gov/pregnancyandbeyond/breastfeeding/easysteps.pdf

Forbes, B. (2011). What is the WHO-CODE? Website: http://www.bestforbabes.org/what-is-the-who-code

Internal Revenue Bulletin. Lactation Expenses as Medical Expenses. (2011). Website: http://www.irs.gov/irb/2011-09_IRB/ar11.html

Jones E., Dimmock, P. W. & Spencer, S. A. ( 2001). A Randomised Controlled Trial to Compare Methods of Milk Expression After Preterm Delivery. Arch Dis Child Fetal Neonatal Ed, 85, F91–F95

Meier, P. Engstrom, J. Janes, J. Jegier, B. & Loera, F. (2012). Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. Journal of Perinatology, 32, 103-110

Morton J., Hall, J., Wong, R., Thairu, L., Benitz, W. & Rhine, W. (2009) Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. Journal of Perinatology, advance online publication,29, 757-764

Shebala, M. (2012, January 26). Benefits of breastfeeding in workplaces touted. Navajo Times, http://www.navajotimes.com/opinions/2012/0112/012612notebook.php

Silver, B. (2010). College and University Lactation Programs, some Additional Considerations. The Elsevier Foundation, University of Rhode Island Schmidt Labor Research Center.http://www.uri.edu/worklife/family/family%20pics-docs/LactationPrograms%20FINAL.pdf

Simmance, A. (2011). Why You Shouldn’t Buy, Sell, or Borrow a Second Hand Medela Swing Pump. Website: http://mythnomore.blogspot.com/2011/08/why-you-shouldnt-buy-sell-or-borrow.html

State of California, California Labor Code § 1030.
2002: Chapter 3.8, Section 1030, Part 3 of Division 2 of the Labor Code http://www.google.com/url?q=http%3A%2F%2Fwww.cdph.ca.gov%2FHealthInfo%2Fhealthyliving%2Fchildfamily%2FPages%2FCaliforniaLawsRelatedtoBreastfeeding.aspx%23workingandbreastfeeding&sa=D&sntz=1&usg=AFQjCNHUWIwkLISI2im9IiolxL9ZB-IVhA

West, A. (2011). The Problems with Medela. Website: http://www.justwestofcrunchy.com/2011/01/19/the-problems-with-medela/

© 2012 Serena Meyer, IBCLC and Teglene Ryan

Posted in Breastfeeding, Women's Issues | Tagged , , , , , , , , , , , , | Leave a comment

Opiate Addiction: Commentary for Breastfeeding Supportive Care

Disclaimer: Native Mothering strongly opposes the use of drugs by breastfeeding mothers unless prescribed by a physician. Please consult your healthcare provider before taking any medications or drugs while pregnant or breastfeeding. This article is not meant to replace the advice of your health care provider or traditional medicine provider. By proceeding, you agree that the contents of this article do not constitute medical or legal advice.

Drugs and Breastfeeding in the News

It is important to realize the increased danger of using street drugs while parenting. For example, there have been several articles in the news about breastfeeding mothers accidentally exposing their babies to methamphetamine in breastmilk, tragically leading to the death of their babies. Another current article describes the illegal use of drugs such as hydrocodone, fentanyl, duragesic, and morphine (opiods); taken in combination by a breastfeeding mother, resulting in her infant’s death. Yet another mother was convicted in 2011 for taking a large amount of morphine while breastfeeding, to intentionally make her baby sick.

Intentional harm of an infant is hardly the norm when reviewing general news on breastfeeding and illegal drug use. Far more commonly, there is little or no individual awareness from the mother herself, that what unauthorized prescription medication or street drugs she takes frequently ends up in varying levels in her milk.

Drugs and Breastfeeding: Laws That Apply

In many U.S. states and territories, parental substance abuse is part of the wider definition of child abuse or neglect, regardless of when it occurs—prenatally or after birth. According to the U.S. Department of Health and Human Services website (US Dept of Health, 2009):

“Specific circumstances that are considered child abuse or neglect in some States include:

  • Manufacturing a controlled substance in the presence of a child or on premises occupied by a child
  • Exposing a child to, or allowing a child to be present where, chemicals or equipment for the manufacture of controlled substances are used or stored
  • Selling, distributing, or giving drugs or alcohol to a child
  • Using a controlled substance that impairs the caregiver’s ability to adequately care for the child
  • Exposing a child to the criminal sale or distribution of drugs

Approximately 25 States and the U.S. Virgin Islands address in their criminal statutes the issue of exposing children to illegal drug activity. For example, in 14 States the manufacture or possession of methamphetamine in the presence of a child is a felony and in four States, the manufacture or possession of any controlled substance in the presence of a child is considered a felony. California, Mississippi, Montana, North Carolina, Ohio, and Washington State have enacted enhanced penalties for any conviction for the manufacture of methamphetamine when a child was on the premises where the crime occurred.

Exposing children to the manufacture, possession, or distribution of illegal drugs is considered child endangerment in seven States. The exposure of a child to drugs or drug paraphernalia is a crime in North Dakota, Utah, and the Virgin Islands. In North Carolina and Wyoming, selling or giving an illegal drug to a child by any person is a felony.”

It is prudent to read and understand the position of your individual state so that you are adequately prepared to support and help the families with whom you work.

Heroin:

Abstaining from heroin is the best choice when breastfeeding. Most street drugs are dangerous to an infant’s health; even in small quantities they can prove fatal. A baby’s liver and kidneys are not as mature as an adult’s, so the effects of the drug are often intensified. Small amounts of the drug may have stronger and longer lasting effects on infants than on adults. Drugs may also accumulate (build up) in infants’ bodies, with the effect of contributing to serious organ damage or death.

It is unethical for a healthcare professional to advise a mother that she can safely breastfeed, even if she reports that she is only using heroin once in a while. Beyond the questionable effects of the heroin itself, it is often not possible to know if the drug has been cut with other substances. The presence of “cutting” agents may allow more unknown toxic substances to pass through breastmilk to the baby. In short, the true content of street drugs are always an unknown.

Causes for Immediate Weaning

If you believe a mother may be habitually or occasionally using heroin, other street drugs, or misusing pills of any kind, it is critical to suggest that she immediately wean her baby and switch to another method of feeding. It is a protective practice to offer your client a referral to a drug treatment program that accepts children, if you do not have such a program in your area, consider compiling a list of free or low cost support groups. Narcotics Anonymous is free, and meetings may be found here: http://www.na.org/

In some rare medically supervised situations, if the mother is voluntarily getting substance misuse treatment, is not currently breastfeeding, is no longer using, and has passed into a clinically safe period when her milk is clean of all residual drugs, an experienced Lactation Consultant may be able to work with her to help her maintain her milk production and reintroduce breastfeeding later. Reintroduction would depend on whether she is considered medically stable, at low risk of using again, and is actively collaborating with a healthcare team.

The risks would be high for the infant if the mother had insufficient support systems, difficulty staying clean, was unable to test clean, or failed to meet the conditions of her drug treatment plan. In this case it would be imperative to immediately facilitate another method of feeding that did not include breastfeeding by the mother or the mother expressing breastmilk for bottle feeding.

Heroin and Breastfeeding

If a mother is using heroin and breastfeeding, she should be told to wean immediately. Dr. Hale (2010, p. 500) lists heroin as an L5 lactation risk. This means it is considered unsafe, is contraindicated in breastfeeding mothers, and should be avoided while breastfeeding.

Heroin users—whether part-time or regular users—should be discouraged from breastfeeding for several reasons. Some people combine heroin use with methamphetamine, cocaine, alcohol or other drugs. Combining street drugs is unsafe for adults; it is particularly dangerous for babies who have immature livers and kidneys. A typical drug dose for a breastfeeding mother could be deadly for her infant.

Non-prescription Opiod Use in Mothers

If you are working around a population of people that use street drugs, you may have noticed the increase in misuse of opiod medications versus heroin itself. A study on toxicology reports from deceased poly-drug users (Minett, et al. 2010) stated that, “…the Boston Public Health Commission has found that deaths from drugs and alcohol have risen dramatically from 2005 to 2006 mainly because of an increase in inexpensive heroin and the growing addiction to prescription medications.” This speaks to evidence that as a population of addicts begins to use accessible pain medication for recreational purposes, the rate of overdose, and miscalculation involved with strong analgesics will increase. Unregulated opiate use, whether it is in pill, power, tar, or liquid form, combined with other drugs or by itself, can pose considerable negative effects or death on nursing children. Sadly, the rates of overdose in the adult population is higher in the childbearing years between 19-30, meaning that it is likely that the children of addicts have an increased chance of suffering the loss of a parent, living in poverty or that they may have had prenatal drug exposure during their formative period themselves.

Methadone and Breastfeeding

A 2008 study by the American Academy of Pediatrics concluded that breastfeeding women taking maintenance doses of methadone should be encouraged to breastfeed. “Results contribute to the recommendation of breastfeeding for methadone-maintained women.” (Janesson, et al. 2008)

Methadone use while breastfeeding may be acceptable if the mother is in treatment, under the care of a physician, and has given birth to a drug-dependent baby. In cases such as these, Dr. Hale (2010, p.667) recommends that the mother must be very careful and that she should observe the infant for “sedation, respiratory depression, addiction, withdrawal syndrome, neonatal abstinence syndrome.” If the mother is unclear about the signs of sedation in an infant/toddler, she must be immediately directed to contact her healthcare provider for clarification and instruction.

In a study of the effects of methadone use on breastfeeding infants, Keegan and colleagues (2010) concluded that: “…Neonates should be observed for signs of adverse effects, such as gastrointestinal side effects, sedation, and feeding pattern changes. For heavy narcotic abusers and women in methadone treatment programs, the postpartum time period is an excellent time to readdress the possibility of gradual narcotic withdrawal and continued rehabilitation.”

The small amount of methadone present in breastmilk has been reported to help with neonatal abstinence syndrome (NAS). NAS describes drug withdrawal in infants. A mother should speak with her healthcare provider about making safe and healthy breastfeeding choices for her baby.

Complications with Methadone

Serious complications may arise if a mother takes other medications or drugs in addition to methadone. Any change in medications would require close supervision of her infant for sedation and other dangerous side-effects. The first priority must always be the safety and health of the baby.

Are the Effects of Using Heroin the same as Using Methadone when a Mother is Breastfeeding?

No. Methadone is measured precisely and physicians know the exact dose a mother is taking—thus the amount of the infant’s theoretical dose through breastmilk can be estimated. This is not possible with heroin because the potency and dose may vary, and heroin may be cut with a variety of other substances of unknown quantity. If a mother has been using heroin while pregnant, it is advisable to immediately direct her to a substance use treatment clinic for evaluation. The best time to get support to quit is prenatally. A mother can talk to her physician about her desire to breastfeed, and ask for advice on how to get help for addiction.

Mothers in Recovery

The stigma of being in recovery from drug addiction is understandably difficult; it often comes with heartache and a loss of control and accountability. A mother in early recovery has a tremendous amount of work ahead of her, but it doesn’t have to prevent her from forging a strong bond with her baby. A child will benefit from a family that gets clean, stays clean, and actively parents. A mother’s choice to breastfeed should be respected and honored. Additionally, a mother should takes steps to avoid putting herself in a position of risking her recovery from drug use, because of her social circle, environment or location.

Breastfeeding after Physical Abuse

Women all over the world may have been recipients of undesired physical or sexual contact. This can especially be an issue for mothers who use drugs or are recovering from drug use. You can read more on the topic of supporting survivors of abuse here.

Recovery Resources

Directing a mother to local support groups through a methadone clinic or Narcotics Anonymous (NA) may increase her chances of successfully staying clean. Check the NA website to find an NA meeting near you: http://www.na.org/?ID=home-content-fm

References

Academy of Breastfeeding Medicine Protocol Committee. ABM Clinical Protocol #21: Guidelines for Breastfeeding and the Drug-Dependent Woman.  Breastfeeding Medicine Vol. 4, No. 4, 2009. Mary Ann Liebert, Inc.

Child Welfare Information Gateway. (2011). Definitions of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.

Fisher, Denise MMP, BN, RN, RM, IBCLC . Social Drugs and Breastfeeding. 2006 http://www.health-e-learning.com/resources/articles/40-social-drugs-and-breastfeeding

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*In conclusion, I would like to acknowledge the assistance and support of Yvette Malamud Ozer, who devoted time editing and adding in suggestions when needed. These acts of kindnesses from our friends must be appreciated.

 

(c) 2015 Serena Meyer RN, IBCLC. All Rights Reserved


 

 

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