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Should I Breastfeed?

Is Breast Still Best When I Take Medication, Drink, Smoke or Use Drugs?

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Updated June 10, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

As a mom, you know that breastmilk provides the best nutritional and developmental start for your baby. And you know that a clean and sober lifestyle will help you to provide the best quality of breastmilk, as well as the best chance at good parenting. But many moms aren't able to remain completely abstinent from caffeine, medications, and other addictive substances, for a whole variety of reasons. Many also fear discussing this with their doctor, in case they are seen as a bad mother. The choice to breastfeed when you take substances that could enter your breastmilk is a complex choice, but not automatically a no-no.

1. Caffeine When Breastfeeding

Breastfeeding mom and baby share coffee
Image (c) Marc Romanelli / Photodisc / Getty Images

Caffeine is known to enter the breastmilk of women who consume it, and many breastfeeding mothers, exhausted by the inevitable sleepless nights, think nothing of perking themselves up by drinking caffeinated drinks, such as coffee and tea, during this time. And doctors, themselves often heavy users of caffeine, don't often prioritize discussion about caffeine intake while breastfeeding.

Yet caffeine is a stimulant, and may have a significant impact on your baby's ability to settle to sleep. It also has a number of harmful effects on the body and the brain, including cardiovascular effects and reduction in bone density. Remember, you can also get caffeine from energy drinks, and several common foods and drinks.

2. Smoking When Breastfeeding

Image (c) Peter Cade / Getty Images

Nicotine, the psychoactive and addictive substance in cigarettes, is transmitted to the baby in your breastmilk, and has a half-life of about an hour and a half within your breastmilk. Exposure to nicotine through breastmilk can cause nicotine dependence and nicotine poisoning in your baby.

It's best to quit smoking before breastfeeding. If you choose to smoke and breastfeed, smoke after feeding your baby, not before. Try and wait three hours before breastfeeding again, even if you have to express and discard some breastmilk in between. When you do smoke, avoid exposing your baby to secondhand and thirdhand smoke.

Smoking may inhibit your milk production, and reduce the level of vitamin C that your baby is getting through your breastmilk.

3. Drinking When Breastfeeding

A woman and baby sleeping after drinking then breastfeeding
Image (c) Peter Dazeley / Getty Images

If you drink alcohol while breastfeeding, it will be transmitted to your baby in your breastmilk. Research into babies exposed to alcohol in this way indicate that the baby can become more fussy, or conversely, that they can become more drowsy -- increasing the risk of SIDS. Exposure to alcohol through breastmilk has also been found to cause declines in infant development. In extreme cases, exposure to alcohol through breastmilk can be dangerous.

It is safest to avoid alcohol completely while breastfeeding, but if you do choose to drink and breastfeed, feed your baby before rather than after drinking. Calculate your Blood Alcohol Content for Women to determine how long you should wait after drinking before breastfeeding your baby.

4. Medications When Breastfeeding

If you are taking medications, you should discuss the potential benefits and drawbacks of breastfeeding with your doctor or pharmacist. There is no stigma in raising this subject, except in women who over-use medications. In fact, your doctor should already be aware of your recent pregnancy or adoption and your wish to breastfeed, and should have advised you when they prescribed your medication.

But if you are self-medicating with over-the-counter medications, such as ibuprofen, your doctor may not be aware you are doing this. Book an appointment as soon as possible, and ask your doctor's advice. Find out if you could reduce or eliminate the medication you are taking by managing your symptoms or problems using non-pharmaceutical therapies.

5. Marijuana When Breastfeeding

About 0.8% of the psychoactive ingredients of marijuana ingested or smoked by the mother enter the breastmilk, and can be consumed by the baby in one feeding. In heavy marijuana smokers, the amount can be 8 times higher in breastmilk as it is in the mother's bloodstream. Furthermore, a study found that babies who have been exposed to marijuana through their mother's breastmilk do have decreased motor functioning at one year old.

The safest choice is to quit marijuana while you are breastfeeding. Marijuana withdrawal is mild enough to safely quit on your own without detox, although counseling often helps. If you are using medical marijuana, talk to your doctor about other options for managing your symptoms. If you can't quit, don't breastfeed.

6. Drugs When Breastfeeding

If you are actively using drugs such as heroin, cocaine, or meth, breastfeeding is probably too risky to be recommended, although babies with NAS are often soothed by breastfeeding. The most risky aspect of breastfeeding when you use illicit substances is not knowing exactly what your baby is being exposed to, as these drugs are almost always heavily cut with other substances.

However, if you have been drug-free for three months and you have adequate support to stay clean -- from your partner, your doctor, and your drug counselor if you have one -- you and your baby can benefit from breastfeeding. If you relapse, don't breastfeed until you are clean again, and the drug is out of your system. This usually takes about a week.

Sources:

Berger, M.D., M.P.H., L., "When Should One Discourage Breastfeeding." Pediatrics 67:300-302. 1982.

Clement, M., "Caffeine and Babies." British Medical Journal 298:1461. 1989.

Cook, P., Petersen, R. & Moore, D. Alcohol, Tobacco, and Other Drugs May Harm the Unborn. DHHA (ADM) Report No. 92-1711. 1990.

Djulus, M.D., J., Moretti, M.S.C., M., &Koren, M.D., F.R.C.P.C., G., "Mariijuana Use and Breastfeeding." Canadian Family Physician 51:349-350. 2005.

Liston, J., "Breastfeeding and the Use of Recreational Drugs -- Alcohol, Caffeine, Nicotine and Marijuana." Breastfeeding Review 6:27-30. 1998.

Wilton, J., "Breastfeeding and the Chemically Dependent Woman." NAACOG's Clinical Issues in Perinatal and Women's Health Nursing 3:667-672. 1992.

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