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General Guidelines for Breastfeeding Women

Personal Habits
Expectant mothers typically are conscientious about modifying any lifestyle habits that could pose a risk to their developing baby. Most are eager to comply with advice to abstain from alcohol or illicit drugs, stop smoking, avoid caffeine, decrease their consumption of junk foods, and eliminate unnecessary medications. Basically, the same health principles recommended for pregnant women continue to apply during lactation. I have encountered many women who are so committed to their babies' welfare that they are able to overcome destructive personal habits on behalf of their infant even when they previously have been unsuccessful in doing so for their own good. Many women acknowledge that the positive lifestyle changes they make while carrying and nursing a baby represent a significant bonus to their own well-being.

The risks to the fetus of alcohol consumption during pregnancy have been well publicized. Fetal alcohol syndrome can result in stunted growth, mental retardation, and abnormal appearance. Fortunately, most women are motivated to abstain from alcohol during pregnancy.

Following delivery, many women wonder whether they can safely drink any alcoholic beverages while breastfeeding. Advice concerning alcohol consumption during breastfeeding has been very confusing. For years, nursing mothers were reassured that a glass of beer or wine would help them relax and facilitate their milk ejection reflex. Beer was believed to raise prolactin levels and improve a mother's milk production. Recently, however, a study showed that babies obtained less milk when nursing after their mothers drank some alcohol. Alcohol is passed readily into human milk, and consumption of large quantities can sedate the nursing infant and cause other adverse effects. Both binge drinking by nursing mothers and daily drinking of even small amounts of alcohol now is believed to be harmful to breastfed infants. One study has shown lower motor developmental scores at a year of age in breastfed babies whose mothers consumed one or two alcoholic drinks daily.

Current recommendations are that nursing mothers can drink an occasional beer or glass of wine. To completely forbid alcohol during breastfeeding would probably discourage some women from nursing. On the other hand, permitting some alcohol intake during lactation should never be misinterpreted to condone heavy consumption among women with a drinking problem. I advise breastfeeding mothers to limit their consumption of alcoholic beverages to two drinks per week. You should not breastfeed for at least 2 hours per drink consumed to mimimize the presence of alcohol in your milk. I no longer suggest a glass of beer or wine to relax an anxious mother or to enhance her milk production or improve her let-down reflex.

If you are struggling with an alcohol problem, I urge you to face it. Don't put off any longer getting the help you need and deserve!

Recreational Drugs
Recent studies have shown that up to 10 percent of babies are exposed to an illicit substance while still in the uterus. This distressing statistic is a sad testimony to the rampant drug abuse that plagues our society. I must take a rigid stand on illicit drug use by breastfeeding women. Marijuana, speed, crack, cocaine, heroin, and the other mood-altering drugs of abuse do appear in breast milk and pose a very serious threat to the nursing baby. Several instances have been documented in which breastfed infants were harmed when they ingested an illicit drug through their mother's milk. Infant fatalities have occurred, and a few mothers have been charged with felony child abuse-and even murder-because they used illicit substances that endangered their breastfed babies. The American Academy of Pediatrics strongly insists that no drug of abuse, including amphetamines, cocaine, heroin, marijuana, and PCP, should be taken by nursing mothers. I can't say it emphatically enough: substance abuse is incompatible with breastfeeding! In addition to posing a serious hazard to nursing infants, drugs of abuse are detrimental to the physical and emotional health of mothers (whether they breast- or bottle-feed). A drug-abusing mother is emotionally unavailable to her baby and is incapable of meeting her infant's emotional and physical care needs.

Having stated this, let me make it clear that I do support former substance-abusing women in their desire to nurse their babies while staying clean. Such women may be able to breastfeed provided they: remain drug-free; are enrolled in a drug treatment program; receive close follow-up, with regular postpartum urine drug screening; and test negative for HIV. Discuss your situation with both your own and your baby's doctors.

From Dr. Mom's Guide to Breastfeeding by Marianne R. Neifert. Copyright © 1998 by Marianne R. Neifert. Used by arrangement with Plume, a member of Penguin Group (USA) Inc.

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