How Substance Abuse Affects Breastfeeding

The World Health Organization (WHO) recommends that infants obtain all of their nutritional requirements solely from breast milk for the first six months of their lives. After that age, the WHO suggests to continue breastfeeding until the child is at least 2 years old while introducing other foods into his or her diet.

Why is breast milk and breastfeeding the preferred choice?

The Benefits of Breast Milk and Breastfeeding

According to the American Pregnancy Association (APA), breast milk offers the growing child a variety of nutrients that include:

  • Protein for “quick and easy digestion” and reduced likelihood of infections
  • Carbohydrates that reduce unhealthy bacteria and aid in the absorption of the other vitamins in breast milk
  • Fat for proper brain and nervous system development
  • Multiple vitamins (A, B, C, D, E, and K), all of which contribute to the baby’s overall health and well-being

Essentially, breast milk offers many nutrients that help “protect against infections and reduce the rates of later health problems including diabetes, obesity, and asthma” says the APA, adding that the act of breastfeeding itself offers benefits too. It helps stop the bleeding after delivery, reduces the risk of breast and ovarian cancers, and strengthens the mother-child bond.

That’s why many health experts are so intent on making sure a mother has access to adequate care during the breastfeeding process. In order for her baby to get the proper nutrients through breast milk, the mother must get them first so she is able to pass them down.

But what happens if the breastfeeding mother ingests other substances? More specifically, what is the effect of various drugs—both legal and illegal—on lactation and breast milk?

Effects of Drugs on Lactation and Breastfeeding

Because nutrients in the breast milk come from the nutrients consumed by the mother, the same can be said about any other substances she ingests. Simply put: if a mother puts drugs of any kind in her body, they’re likely to be passed along to the nursing baby.

Therefore, specific recommendations exist regarding each drug—some of them legal and some of them illegal—and its consumption by a breastfeeding mother. Let’s go through a few of the most common now.


Caffeine provides a lot of benefits. According to Michigan State University, these include protection of brain cells, reduced risk of gallstones, prevention of various heart illnesses, and the ability to relieve headaches. But what does it do to breast milk?

Research has discovered that peak concentrations of the caffeine within the breast milk occur 60 minutes after ingesting it. The American Academy of Pediatrics (AAP) also says that less than 1 percent will transfer to breast milk.

Because this amount is so low, the AAP states that consuming caffeine is okay while breastfeeding, though this organization does recommend that it be consumed in moderation. If you spread your intake over the entire day, that helps as well.

However, if you notice that your baby is irritable or fussy, the AAP suggests that you try cutting down on your caffeine to see if that helps. This may involve limiting it for one hour before feedings so less is passed along to your baby.

Keep in mind also that caffeine comes from a variety of sources beyond coffee, tea, or soda. It is also in chocolate and many headache medications too.


Another drug sometimes consumed by new mothers is alcohol. But what does science have to tell us about alcohol and breast milk?

One study published in the New England Journal of Medicine included 12 lactating women, each of whom consumed 0.3 grams of ethanol alcohol per kilogram of body weight. For comparison purposes, the alcohol content of a few standard drinks includes:

  • Beer, 12 ounces – 5 percent alcohol
  • Wine, 5 ounces – 12 percent alcohol
  • Liquor, 1.5 ounces – 40 percent alcohol

Researchers discovered that after the mothers drank the alcohol, the odor of their breast milk became more intense for 30 minutes to one hour. Furthermore, the smell was the strongest when the alcohol content within the breast milk was at its peak.

This study also found that “the infants sucked more frequently during the first minute of feedings after their mothers had consumed alcohol… [but] they consumed significantly less milk.” Based on this, the researchers concluded that consumption of alcohol affects an infant’s feeding behaviors.

For reasons such as these, the National Institute on Drug Abuse (NIDA) suggests that nursing should be avoided for two hours after drinking. This way, any alcohol that has been consumed has adequate time to leave the mother’s body before potentially being passed on to the infant.

That being said, the NIDA also says that science has found that “alcohol does not increase a nursing mother’s milk production, and it may disrupt the breastfed child’s sleep cycle.” So, if you’re struggling with getting enough milk to adequately feed your infant or if he or she is having trouble sleeping, alcohol may be the culprit.


The Centers for Disease Control and Prevention (CDC) estimates that roughly 13.6 percent of the female population currently smokes. Additionally, those in the 25 to 44-year-old range smoke more than any other age group, with 45 to 64-year-olds coming in a close second.

Though the negative impact of smoking on the body includes major issues such as an increased risk of heart disease and cancer, there are other effects as well. For instance, people who smoke see a faster decline in vision, often have more wrinkles, and, for women in particular, tend to enter menopause at an earlier age.

Research has found that smoking while breastfeeding can also have negative consequences for the infant. For instance, one study published in the journal Pediatrics discovered that babies slept less if they consumed breast milk within 53.4 minutes of the mother smoking.

The American Cancer Society (ACS), adds to this topic, advising that smoking while breastfeeding has been linked to troubles with feeding, colic, and sudden infant death syndrome, or SIDS. Thus, they advise that not is the best choice. But if you do choose to smoke, they also indicate that “breastfeeding is probably still healthier for a baby than bottle feeding.”

Another concern is the mother’s exposure to secondhand smoke and whether the toxins can be transferred through the breast milk to the infant. Pediatrician and breastfeeding expert Jennifer Thomas says, “Even though trace chemicals from tobacco do pass into breast milk when a mom breathes in secondhand smoke, the disease-fighting cells in the breast milk outweigh the negative effect of those chemicals.” In other words, it’s more beneficial to the baby to have the breast milk, even if you’ve been around a smoker.

When talking about nicotine, there is also now the electronic cigarette, or e-cigarette for short. Midwife Clare Littler says that the long-term effects of these nicotine sources is not known, which is why she recommends vaping (the term used for smoking an e-cigarette) only after breastfeeding so it has a smaller impact on your breast milk.


Elizabeth Hartney, PhD, registered psychologist, professor, and Director of the Centre for Health Leadership and Research says that “cannabis is the most commonly used illicit drug among pregnant and breastfeeding women.” What effect does this have on a nursing infant?

According to research, tetrahydrocannabinol (THC), the psychoactive compound in marijuana, “is present in human milk up to eight times that of maternal plasma levels.” And because it has been found in the feces of infants exposed to it, it’s fairly clear that their bodies are absorbing and metabolizing this drug.

The Alcohol & Drug Abuse Institute (ADAI) adds that THC passed via breast milk can be “stored in the baby’s fatty tissue for several weeks.” This can create a variety of issues for the infant, ranging from experiencing tremors to poor feeding behaviors, and even decreased motor development.

Additional risks to breastfed children exposed to marijuana have been found to include:

  • Impaired development of the brain and nervous system
  • Decreased mental function
  • Emotional regulation issues
  • Hyperactivity
  • Sudden infant death syndrome, or SIDS

Because of this, Hartney advises that a breastfeeding mother not use marijuana at all. The American College of Obstetricians and Gynecologists (ACOG) agrees. And if you do use marijuana, Hartney suggests foregoing breastfeeding altogether.

If you decide to stop using marijuana in order to breastfeed, Hartney suggests that you do so 90 days before you expect to start breastfeeding because this drug stays in your system for an extended period of time.


The term “opiates” refers to a variety of drugs. A common street-level opiate is heroin. In the case of this drug specifically, some case studies have shown that a child breastfed by a mother addicted to heroin also became addicted to heroin themselves.

Children exposed to heroin through breast milk often have negative physical reactions as well. These include abdominal cramping, diarrhea, increased heart rate, and respiratory distress.

Some opiates are available legally, via a prescription. A couple of them are commonly prescribed to help individuals overcome their heroin addiction (methadone or buprenorphine), and others are generally referred to as painkillers that include codeine, hydrocodone, and oxycontin.

Though these prescribed opiates can be passed down to nursing babies too, guidelines published in Breastfeeding Medicine suggest that breastfeeding should continue with prescription opiates “regardless of dose.” However, use should be monitored by a physician who specializes in breastfeeding to ensure that it is safe for the baby. This is critical as some research has found that opioid toxicity can occur in breastfed infants.

The CDC adds that opiates in the form of codeine should either be avoided or taken in the lowest dosage possible during breastfeeding because they can potentially increase an infant’s risk of illness or even death.


The Substance Abuse and Mental Health Services Administration explains that stimulants “make people more alert [and] increase their attention.” Drugs that fall into this category include illegal options (cocaine and methamphetamine) and those that are prescribed (Ritalin, Adderall, and Dexedrine).

As with the other drugs, stimulants can be passed to the baby via the mother’s breast milk. Therefore, each one comes with its own recommendations with regard to breastfeeding.

For example, in regard to cocaine specifically, research published in the journal Canadian Family Physician says that even small amounts are dangerous to babies because they can’t adequately metabolize this drug. This can lead to agitation and irritability, but it can also lead to hypertension, tachycardia, and seizures.

For this reason, researchers recommend that mothers abstain from breastfeeding for at least 24 hours after using cocaine “to allow for drug elimination.” This helps limit the baby’s potential exposure to the drug.

Similar results have been found with methamphetamine use, which is also detectable in breast milk. In some cases, meth use during breastfeeding has led to the infant’s death. With regard to prescription stimulants, some studies have found that when they’re taken during breastfeeding, they aren’t known to cause any malformation issues, such as heart defects, finger abnormalities, or limb malformations. However, it is possible that they may negatively impact the mother’s production of milk when taken in larger doses, so it’s best to consult with a physician to ensure that you’re within a safe a healthy amount.

October 6, 2018 / by / in
Do You Have To Breastfeed In The Hospital? Here’s What You Need To Know

There’s been a recent trend in hospitals pushing towards more baby-friendly practices and less overall medical intervention. Hospitals are reverting to more natural methods of labor, delivery, and postpartum care as the knowledge and research surrounding maternity care and women’s health continues to change and advance. This leaves a lot of questions for someone about to deliver however, especially if your personal beliefs or desires don’t match your hospital’s practices. Like, do you have to breastfeed in the hospital or is formula still an option?

According to Slate, the push for “baby-friendly” hospitals is not new, but there has been a recent revival over hospitals having the status. “Baby-friendly” is a specific certification given to hospitals who fulfill a rubric developed by UNICEF and the World Health Organization to promote breastfeeding. In order to attain this, hospitals must practice rooming in (no bringing babies to the nursery), give babies nothing but breast milk unless medically indicated, and no pacifiers. So, if you choose to deliver your baby in a hospital indicated as “baby-friendly,” it’s likely that you’ll be encouraged to breastfeed. It’s a good idea to look into your chosen hospital’s practices well before you’re due to deliver.

The response towards the push for “baby-friendly” hospitals has been mixed. Though many moms love the “baby-friendly” practices, others feel pressured to do things they don’t necessarily want to do.

Every hospital has a bit of a different flavor but with the move towards encouraging breastfeeding and the new baby-friendly initiatives, breastfeeding definitely plays a more central role in the first few postpartum days, Dr. Idries J. Abdur-Rahman, MD​, tells Romper. “The general approach now,” he says, “is to strongly encourage breastfeeding by enumerating the many benefits for mom and baby, while unfailingly respecting a women’s individual decision to breastfeed or not to breastfeed.”

For those moms who opt to breastfeed, the push towards baby-friendly practices are designed to stimulate a strong breastfeeding relationship and to make the transition as easy as possible for both mom and baby, notes Abdur-Rahman. This includes encouraging skin-to-skin contact as soon as possible after delivery, encouraging baby to latch on as soon after delivery as possible (for both vaginal deliveries and for C-sections), having a certified lactation consultant in the hospital, and having baby “room in” with mom.

“All in all, things are definitely more pro-breastfeeding than they were in the recent past,” says Abdur-Rahman, “The default was to to give all babies a bottle unless mom specifically requested otherwise, but that has now flipped to only giving bottles to baby if mom requests it or if there is a medical indication for formula.”

That being said, hospitals shouldn’t require a mother to breastfeed before offering the baby a bottle (Dr. Abdur-Rahman notes that he doesn’t know of any that do). For a multitude of medical, physical, and cultural reasons, some women just don’t want to or cannot breastfeed and that is completely their decision, he says.

And, all hospitals do have formula on hand. There are a multitude of medical reasons why babies need formula, including stabilizing their blood sugar — which is a common problem for larger babies and babies born to diabetic mothers.

Whether or not you choose to breastfeed is not as important as being confident and vocal in your choice during pregnancy and while in the hospital for delivery. “Patients have got to feel comfortable with their doctor or midwife, as we are supposed to be their ultimate advocates,” says Abdur-Rahman.

Women have got to speak up and be their own advocates, he says. “They have to feel comfortable sharing what they want and what they don’t want, as well as ask questions about those things they just are not sure about.” His one piece of advice? Feel comfortable enough with your provider to talk about anything, including your desires for your child, labor and delivery, and breastfeeding. If you are not comfortable, get comfortable, and if you cannot get comfortable, consider seeing someone else. It’s that important.


May 15, 2018 / by / in
Local Effort To Get More Women Breastfeeding Targets Dads

August is World Breastfeeding Month, and several local organizations are hoping a new take on breastfeeding will get more moms to try it with their babies. And, the effort seeks to educate dads about breastfeeding to get them more involved in the process.

Research shows that 39-percent of Florida’s children born in 2008 were breastfed for the first six months, with only 20-percent breast fed for a year. That’s less than the two years recommended by the World Health Organization as well as the American Pediatric Association.

And, it’s partly because of stigmas or misconceptions associated with breastfeeding children.

“You hear, your breasts are going to sag, you hear some men don’t really want their or she might have the same view that this is a sexual thing, this is not a feeding mechanism, other ones are you’ve got a child that’s really spoiled, or here you’ve got a child who is a ‘booby-baby,’ who’s up under their mom too much,” remarked Quashier Flood-Strouble, a breastfeeding peer counselor and a certified lactation counselor in Tallahassee.

She says while the breastfeeding trend is starting to improve by educating more women, she feels there is one group of people that is getting lost in the breastfeeding process: men.

So, she and her brother, Mu-Tor Flood, created a movie aimed at helping fathers understand how integral they are to the breastfeeding process.

The locally-made film is called “Dads and Breastfeeding: The Official Guide for New Fathers.” Flood-Strouble says the influence fathers have shouldn’t just come into play when it comes to deciding whether to breastfeed.

For example, she says she had originally planned to have a natural birth with her first son, but due to complications, she later had to undergo a C-Section. Flood-Strouble says she had wanted to get her son breast feeding right away, but she couldn’t speak up because she was so tired from the ordeal and the drugs in her system. And, that’s when her husband Bruce Strouble stepped in:

“And, the nurses were actually trying to give him formula. I knew she wasn’t going to go for that. So, I had to be her mouthpiece basically,” said Strouble. “So, I had to go there and say no, no, no! She’s going to pump. They’re got her on the pump, and I’m running the colostrum [pump] down so that they can feed the baby. That’s just one way you help. Being there, being involved, and help her stay with it by just staying supportive.”

And, now Breastfeeding in the Strouble family is a tradition that’s carried down to their two other sons.

It’s also a practice that Bruce Strouble hopes to spread throughout the community. He and his group, Citizens for Sustainable Future Incorporated, recently held a panel discussion at the Leon County Health Department about the importance of breastfeeding. Included in the effort are the Florida Department of Health’s Office of Minority Health, Whole Child Leon, and the county’s health department.

Dykibra Gaskin is the nutrition educator at the Leon County health department who works with women, children, and infants. She says critics often turn the image of mothers feeding their babies in public into a sexual act because they believe the breast is indecently exposed. She says what fathers can do is to try and de-sexualize the breast by playing a more active role in defending it. Gaskin says in fact, she’s seen dads who do just that.

“They’re really cool about it. They’re like well, this is how she feeds our baby,” said Gaskin. “We have to be really nonchalant about it. This how we feed our baby. Bottles are not an option. So, men can play a role by defending his wife, defending his baby. Speak up! Don’t play a passive role!”

Doctor Esaias Lee, who practices Family Medicine at Capital Health Plan, says dads should also be prepared to help with the discomfort breastfeeding moms sometimes face when the baby’s mouth latches on, and encourage moms not to quit.

“As a dad, through your reading, you learn that you may need to get some dish clothes, maybe get them moist,” said Dr. Lee. “And, begin to help your soulmate, your wife or your significant other prepare her nipple to deal with some of this discomfort. So, it’s almost like you guys are in training camp as a couple. You’re trying to prepare yourself for this upcoming event so that you all can give your baby the best type of nourishment that it can receive.”

And, Dexter Harrell, a believer in breastfeeding, agrees. The 40-year-old man is the father of four children, including a 15-month old daughter, who is still breastfed. He says he and his wife struggled with breastfeeding his two oldest children, but things worked out for the last two. He says he’s glad he was able to help his wife through the process and points out the benefits are clear.

One of the biggest debates relating to the breastfeeding process is breastfeeding versus baby formula. While experts say some mothers find they don’t have to worry about their diet OR have to feed their babies as frequently because baby formula digests slower than breast milk, Harrell says breastfeeding, for him, wins hands down. He says, mostly because, it saved his family money and it’s very convenient.

Harrell says he encourages all fathers to get on board and involved in the breastfeeding process. He adds the movie is also a beneficial tool to help fathers regarding misconceptions or questions they might have about breastfeeding in general. Harrell and his family can also be seen in the “The Dads Official Guide to Breastfeeding” movie. To learn more about the movie, visit



January 17, 2016 / by / in