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Dear Lactation Consultant:
My sister-in-law is a former drug addict and began a methadone maintenance program knowing she wanted to get pregnant. She is due in 3 months and is planning on breast feeding. Her doctor has given her his blessing. She has begun to interview pediatricians and she has informed me she will find a doctor for the baby who will agree to allow her to breast feed.
My question to you: Can you give me any information on whether she should breast feed and what danger, if any is there to my very first niece? My sister-in-law is a good person who did some pretty stupid things in her past but is working hard to stay clean and is going to be a great mom, so I just need to know from a breast feeding specialist if she is really looking out for the safety and welfare of the baby. You always seem to give excellent advice with back-up when appropriate, which is why I am turning to you.
Thank you,
Nervous Aunt-to-be
Wilmington, DE
Dear Nervous Aunt-to-be:
I can certainly understand your anxiousness and concern for your sister-in-law and your unborn niece and they are both very lucky to have you there for them.
I recently reread a study done in 2007 that basically approved breastfeeding for new mothers on methadone maintenance. “The American Academy of Pediatrics classifies Methadone as a drug usually compatible with breastfeeding and reports no adverse signs or symptoms in breastfed infants of methadone maintained mothers.” (This comes from the AAP Committee on Drugs. "The Transfer of Drugs and Other Chemicals Into Human Milk"; Pediatrics 2001; 108: 776-789 and revised from the original article published in 1994: Pediatrics 1994 93: 137-150. This is readily available as a PDF for you to read by clicking Here.)
Thomas W. Hale, PhD, in the 13th edition of Medications and Mothers’ Milk, states that most studies thus far show that only small amounts of methadone pass into breast milk. The transference is dose dependent but generally quite low and significantly less than the 10% cut-off of the maternal dose corrected for weight. He recommends that the baby be observed for sedation, respiratory depression, addiction, withdrawal syndrome and neonatal abstinence syndrome (your sister should have information on this from her maintenance program therapist).
There are obviously other factors that must be taken into consideration, the greatest of which is the stress being a new mother will put on your sister-in-law and how this may impact her addictive personality. Her husband and the rest of the family needs to keep an eye on her for post partum depression or other risk factors. Make certain she continues her maintenance program and therapy, which if she is not presently receiving, she should be. And, as I said at the beginning of this answer, she is very fortunate to have you as a sister-in-law and a friend. I hope you find this helpful.
--Leslye Adelman, IBCLC
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