NAS/NOWS, Neonatal — Breastfeeding Safety — Clinical Pathway: Inpatient Care

Neonatal Abstinence Syndrome (NAS) /Neonatal Opioid Withdrawal Syndrome (NOWS), Clinical Pathway, Inpatient

Breastfeeding Safety and Contraindications

Breastfeeding Traffic Light

Provides a summary of medications which are safe to take while breastfeeding, those for which there should be caution exercised, and medications and situations for which breastfeeding is contraindicated.

Breastfeeding is discouraged or contraindicated
  • Medical contraindication such as HIV
  • Illicit/licit substance misuse/abuse 30 days prior to delivery
  • Positive maternal urine toxicology testing for illicit substances at delivery and any of the following:
    • No confirmed plans for postpartum substance abuse treatment
    • No confirmed plans for pediatric care
    • Demonstration of behavioral qualities or other indicators of active substance use
    • Use of prescription medications that are contraindicated with breastfeeding
Breastfeeding for mothers engaged in the following is recommended
  • Stable Methadone or Buprenorphine maintenance therapy regardless of dose
  • Engaged in medication assisted treatment program with the endorsement of counselor/treatment provider
  • Plan to continue in medication assisted treatment in the postpartum period
  • Negative maternal urine toxicology testing at delivery, except for prescribed substances
  • Consistent prenatal care

Additional Resources

For the most up-to-date information regarding infant exposure to these and other substances via breast milk. The Infant Risk Hotline can also be contacted: 1-806-352-2519.

Maternal Substance Use and Breastfeeding Recommendations

THC or Cannabinoids
  • Isolated use is not a contraindication
  • Counsel mothers:
    • To abstain from further use
    • Marijuana is passed to the infant via breast milk posing risk to the infant
Selective Serotonin Reuptake Inhibitors
  • Can be associated with adverse effects
  • Review with Lactation consultant
Alcohol
  • Isolated use in not a contraindication
  • Counsel mothers:
    • Breastfeeding is not encouraged if alcohol consumed chronically during pregnancy
    • Alcohol can be passed to the infant via breast milk
    • Women who consume limited alcohol should nurse immediately prior to consumption, then wait approximately 90 - 120 minutes before breastfeeding to minimize exposure to the infant
  • Review with Lactation consultant
Tobacco
  • History of tobacco or nicotine replacement therapy is not a contraindication
  • Counsel mothers:
    • Keep infant’s exposure to cigarette smoke from all sources to a minimum
    • Risk of Sudden Infant Death Syndrome (SIDS) may be increased
    • Nicotine and other substances can be passed to their infant via breast milk
    • Women should nurse their infant immediately prior to smoking a cigarette, not after smoking
    • If they continue to use a nicotine patch while breastfeeding, discuss with their physician so that the lowest appropriate patch dose is selected