Available online 31 October 2022

Section snippetsMagnitude of the Problem

Substance use involves the ingestion of an illicit or prescribed psychoactive drug that may lead to health disparities, social problems, and physical dependence (McLellan, 2017). Substance misuse is defined as the inappropriate ingestion of illicit or prescribed psychoactive drugs that can cause harm to a person’s health or social life over time (McLellan, 2017). According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association, 2013

Benefits and Barriers

The benefits of breastfeeding have been well documented (World Health Organization, 2021); however, considering the high incidence of comorbid conditions, such as trauma (Wright et al., 2021) and mental illness (Cleveland et al., 2020), among pregnant and parenting people who use substances, there are certain breastfeeding benefits specific to this population. For example, parents who use substances perceive breastfeeding as a facilitator to early parent–infant bonding (Yonke et al., 2020), and

Guidelines

While breastfeeding is encouraged for people who use substances, individual considerations should be based on the type of substances used and their potential to cause harm to the nursing infant regardless of whether human milk is provided directly from the breast or expressed.

Medical Contraindications to Breastfeeding

Medical contraindications to breastfeeding for people who use substances and/or have SUDs include the same contraindications that apply to anyone (CDC, 2022); however, there are a few key considerations to highlight:

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Dependent upon the route of substance use, particularly intravenous drug use, people with SUDs may be at greater risk than others for contracting bloodborne diseases such as HIV and hepatitis C.

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In the United States, HIV infection is considered a contraindication to breastfeeding (

Counseling

Early lactation support and current, accurate, and consistent information are essential for all breastfeeding people (McGlothen et al., 2018). The postpartum period is a time of elevated risk for return to substance use for people in recovery; this often occurs in the presence of substance use–related stigma experienced in the perinatal period (Schiff et al., 2018). Additionally, social determinants of health, including race and socioeconomic status, are strong predictors of breastfeeding

Acknowledgment

AWHONN members Lisa M. Cleveland, PhD, APRN, CPNP, IBCLC, FAAN; Allison D. Crawford, PhD, RN; and Kelly McGlothen-Bell, PhD, RN, IBCLC, are acknowledged for their contributions to this practice brief.

AWHONN Contextual Statement: Although the words “woman,” “women,” and “mother” and related pronouns are used herein, AWHONN recognizes the existence of diverse gender identities and acknowledges that not all individuals who present for care self-identify as women or exclusively as women. When

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© 2022 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc.