Without treatment and with continued drug use, babies can be exposed to the drugs through breast milk. This exposure is not only toxic but potentially addictive or even deadly.[1]
The best and safest way to address the situation is with a medically supervised drug detox. The physical health of both mother and child will improve, and breaking the cycle of addiction will help the mother to be a better parent and more present emotionally and mentally.
Is It Safe to Breastfeed While Going Through Drug Detox?
During pregnancy, drug detox is not always advisable due to the health risks to the child.[2] The decision of whether to detox during pregnancy will be made on an individual basis by medical experts, and medications are often used.[3] However, after birth, drug detox is often recommended as one of the first courses of action, especially if the mother wants to breastfeed.
Whether or not drug detox is appropriate for a mother who is breastfeeding should be determined by her doctor. The decision may be impacted by the primary drug of abuse and the type of detox they are undergoing.
In some cases, especially if detox will be brief, the mother may be advised to “pump and dump,” or pump breast milk and then get rid of it rather than feed it to the baby. This will allow her to keep up her breast milk supply without giving her child any milk that contains drugs or alcohol.[4] Again, medical professionals will advise individuals whether this is acceptable or recommended, depending on personal situations and the substance in question.
In the case of opioid use disorder (OUD), if the mother is on a methadone maintenance program, she may be given the green light to breastfeed. Studies show that methadone levels stayed low in breast milk regardless of dose, and the neurobiological development of the child was not affected.[5]
Potential Risks Associated With Detoxing While Breastfeeding
Every situation is unique, but there are several potential risks to consider when choosing whether or not to breastfeed while detoxing. Some of these include the following:[6-9]
Substance Transfer
As the body flushes drugs and alcohol out of the system, breast milk may contain harmful drugs and toxins that could present risks to the infant.
Withdrawal in Infants
Withdrawal is possible in a breastfeeding infant if the mother has been abusing drugs and suddenly stops. Since this situation can be very dangerous, it’s important to work with an addiction treatment team and medical professionals to ensure the safety of both the mother and the baby throughout this process.
Physical Strain
Detox can be physically draining and may lead to dehydration and malnutrition if it isn’t managed appropriately. This can have a detrimental impact on the mother’s health and her ability to produce enough breast milk.
Medication Concerns
Many medications can be valuable during the detox process but may be harmful to the infant if passed through breast milk. OUD maintenance medications like methadone and buprenorphine are believed to be safe during breastfeeding, but other medications used to manage symptoms of detox may not be good for the baby to ingest.
How Are Breastfeeding Women Treated During Detox & Recovery?
As long as it is deemed safe for both parties, mother and child are usually kept together as much as possible during addiction treatment to strengthen their bond. Medical supervision is provided to both patients regularly from start to finish to ensure that everyone is safe.
In most cases, drug detox treatment for women who are breastfeeding and their child includes the following:[10-12]
Comprehensive Assessment
Treating anyone in recovery starts with a comprehensive assessment of their current health, the severity of their substance abuse, and the health of the infant. Medical professionals will be able to start discussing options with the mother as well as their risks, so a collaborative treatment plan can be created.
Medication-Assisted Treatment
If medication-assisted treatment (MAT) is recommended, such as for opioid use disorder, the type of medication prescribed and the dose may be adjusted to minimize risks to the baby. Physicians may be able to prescribe safer medications that don’t interfere with breastfeeding while closely observing the mother and infant.
Prenatal & Postnatal Care
Throughout the treatment experience, prenatal and postnatal care and monitoring are essential. Proper supervision will identify the need for medication changes or other changes to the treatment plan if the mother or child experiences any challenges or complications.
Counseling & Therapy
Mothers should receive counseling and therapy that address their substance abuse, co-occurring mental health challenges, and parenting issues. This helps to create a stable home environment for the child.
Education & Support
Education about the benefits of breastfeeding and lactation assistance can support mothers in recovery who want to continue breastfeeding.
The Benefits of Choosing Detox During Pregnancy
Addiction treatment is recommended during pregnancy to support the health of mother and baby. While an abrupt cessation of drug use is almost never recommended, there are maintenance programs that can help to stabilize the development of the fetus while also helping the mother to transition out of active addiction and into full recovery.
The biggest issues with detox during pregnancy generally relate to low completion rates and high relapse rates.[13]
The benefits of detox and addiction treatment during pregnancy include the following:[14-16]
Limiting Fetal Exposure to Toxins
Detox during pregnancy seeks to limit the exposure of an unborn fetus to harmful substances found in alcohol and illicit drugs. The goals are to decrease the likelihood of birth defects, NAS, or other complications that could arise as a result of substance use during gestation. In some cases, it is safer for the mother to begin medication-assisted treatment, using medications like buprenorphine (Suboxone) or methadone to address OUD.
Improved Prenatal Care
Addiction treatment will generally prompt improved prenatal care and close monitoring of the mother and fetus throughout pregnancy.
Emotional & Psychological Support
Recovery is challenging on its own, but it can be more difficult when coupled with the stresses of pregnancy. Rehabilitation programs offer robust support, often catering care to the needs of pregnant and postpartum women and giving guidance specifics to the stressors of parenthood.
The stigma attached to drug use during pregnancy can make it harder to stay sober and stick to recovery even with the baby’s health in mind. Addiction detox and rehab programs can provide a strong support system of other women going through the same thing and counselors who are nonjudgmental and understanding. This can decrease the likelihood of relapse during this vulnerable time.
Get Help First
If you are pregnant or breastfeeding, talk to a doctor before you attempt detox. Do not simply stop using drugs or drinking suddenly. You need medical support to ensure you and your baby stay safe throughout the process.[17]
- Breastfeeding and substance abuse. D’apolito K. Clinical Obstetrics and Gynecology. 2013;56(1):202-211.
- Substance use in pregnancy: The medical challenge. Louw KA. Obstetric Medicine. 2018;11(2):54-66.
- Pregnant women and substance use: fear, stigma, and barriers to care. Stone R. Health & Justice. 2015;3(1).
- Transfer of methylamphetamine and amphetamine into breast milk following recreational use of methylamphetamine. Bartu A, Dusci LJ, Ilett KF. British Journal of Clinical Pharmacology. 2009;67(4):455-459.
- Methadone maintenance and breastfeeding in the neonatal period. Jansson LM, Choo R, Velez ML, et al. Pediatrics. 2008;121(1):106-114.
- Neonatal abstinence syndrome. U.S. National Library of Medicine. Published November 9, 2021. Accessed November 8, 2023.
- Buprenorphine. Drugs and Lactation Database, U.S. National Library of Medicine. Published 2006. Accessed November 8, 2023.
- Breastfeeding and substance use: Evidence-based practices guidance document. Indiana Perinatal Quality Improvement Collaborative. Published October 2019. Accessed November 8, 2023.
- Substance use in the breastfeeding woman. Bartholomew L, Lee M. Contemporary OB/GYN. Published September 13, 2019. Accessed November 8, 2023.
- Addressing the specific needs of women for treatment of substance use disorders. Substance Abuse and Mental Health Services Administration. Published 2021. Accessed November 8, 2023.
- Addiction treatment in the postpartum period: an opportunity for evidence-based personalized medicine. Martin CE, Parlier-Ahmad AB. International Review of Psychiatry. 2021;33(6):579-590.
- Integrated programs for mothers with substance abuse issues: A systematic review of studies reporting on parenting outcomes. Niccols A, Milligan K, Sword W, Thabane L, Henderson J, Smith A. Harm Reduction Journal. 2012;9(1):14.
- Opioid detoxification during pregnancy. Terplan M, Laird HJ, Hand DJ, et al. Obstetrics and Gynecology. 2018;131(5):803-814.
- Substance use while pregnant and breastfeeding. National Institute on Drug Abuse. Published April 2020. Accessed November 8, 2023.
- Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. Ecker J, Abuhamad A, Hill W, et al. American Journal of Obstetrics & Gynecology. 2019;221(1):B5-B28.
- Basics about opioid use during pregnancy. Centers for Disease Control and Prevention. Published July 1, 2019. Accessed November 8, 2023.
