Breastfeeding: Potentially Harmful Substances and Disease Contraindications Page 1 of 4 Centracare Health (CCH) Adopts the Following Policy/Procedure For: St

Home , Breastfeeding, Breast milk, Lactation

Breastfeeding: Potentially Harmful Substances and Disease Contraindications Page 1 of 4 CentraCare Health (CCH) adopts the following policy/procedure for: St. Cloud Hospital

Original: (04/08) Minor Review: Full Review: (9/15) Replaces: (06/13) Responsible Person: Chair, SCH Women & Children’s Clinical Practice Council Approving Committee: SCH Women and Children’s Clinical Practice Council Department of Family Practice Department of Pediatrics Medical Director – Family Birthing Center Category: Policy Cross Reference: Toxicology Drug or Alcohol Testing of Pregnant Women and Her Newborn Child Abuse and Neglect: Identification, Reporting and Treatment of Type: Policy

I. PURPOSE St. Cloud Hospital promotes a philosophy of maternal and infant care which advocates for breastfeeding of infants. Health officials agree that breast milk provides the most complete form of nutrition for infants, including premature and sick newborns. However, there are rare exceptions when human milk is not a recommended nutrition source for infants and may be detrimental. II. POLICY The optimal feeding method for the newborn is breastfeeding, using milk produced by the infant’s mother. A breastfeeding friendly environment is a primary goal to ensure the safe initiation and progression of breastfeeding. III. DEFINITIONS a. Pump and Discard – Pump and discard means using a breast pump to empty breasts and then discarding the collected milk. Doing this when the mother’s breast milk should not be fed to an infant allows the mother’s milk supply to stay established so that she may resume breastfeeding when appropriate. b. Safe Milk – Milk which is not contaminated by toxins or specific infectious diseases or harmful substances as determined by laboratory studies and current available evidence. c. Presumptive Positive – The initial in house rapid testing shows a positive result. This result is not final or official until confirmed by the send out laboratory.This result can take several days to become final. IV. OUTCOME STANDARDS All mothers will be supported and encouraged in their desire and efforts to breast feed when medically safe and indicated. V. GUIDELINES Due to the potential health risks to the infant, mothers should refrain from breastfeeding if diagnosed with certain transmittable diseases, or if they have tested positive for illicit chemicals. Under certain circumstances, a physician/provider will need to make a case by case assessment to determine whether a woman’s Breastfeeding: Potentially Harmful Substances and Disease Contraindications Page 2 of 4 exposure or her own medical condition warrants her to interrupt, pump and discard her breast milk or cease breastfeeding. i. St. Cloud Hospital will provide safe nutrition to all newborns. ii. The mother/family of the infant will be educated on the potential adverse effects of breastfeeding unsafe milk to the newborn. iii. Staff will explain the reasoning for pumping and discarding of milk, or the delay in breast feeding as it relates to a positive toxicology screen. iv. Mother’s who wish to breast feed after a positive toxicology screen will be educated to pump and discard expressed milk 10-12 times during a 24 hour period until discharge or until breast milk is determined to be safe to use. v. Tobacco use is not a contraindication to breastfeeding vi. Hepatitis B+ is not a contraindication to breastfeeding vii. Breast feeding is recommended and encouraged for mothers who are in a supervised methadone maintenance program. b. Provide information about infection control measures to any mother with infectious disease. i. Breastfeeding is contraindicated if one or more of the following conditions are true: 1. Mother has a positive human immunodeficiency virus (HIV) screen. 2. Herpes simplex lesion on the breast (may feed from the other breast) 3. Infants with classic galactosemia 4. Mother is taking anti-retroviral medications 5. Mother has untreated and active tuberculosis (TB) 6. Mother is taking prescribed chemotherapy agents such as anti- metabolites that interfere with DNA replication and cell division 7. The infant’s mother is undergoing radiation therapies; however, such nuclear medication therapies require only a temporary interruption in breast feeding If a Presumptive Positive result for: Then: Marijuana Continue to Breastfeed Methadone/Suboxone Continue to Breastfeed Heroin Pump and discard Phencyclidine (PCP) Pump and discard Amphetamines Pump and discard Excessive alcohol use Pump and discard Opium/Opiates Per Provider discretion Methamphetamines Pump and discard Other drugs of abuse Pump and discard

If a final Positive result for: Then: Marijuana Per Provider discretion Methadone Continue to Breastfeed Heroin Consider discontinuation of pumping/Breast Breastfeeding: Potentially Harmful Substances and Disease Contraindications Page 3 of 4 feeding Phencyclidine (PCP) Consider discontinuation of pumping/Breast feeding Amphetamines Consider discontinuation of pumping/Breast feeding Excessive alcohol use Consider discontinuation of pumping/Breast feeding Opium/Opiates Per Provider discretion Prescription Narcotics (abuse of narcotic Consider discontinuation of pumping/Breast opiods) feeding Methamphetamines Consider discontinuation of pumping/Breast feeding Other drugs of abuse Consider discontinuation of pumping/Breast feeding VI. OTHER INFORMATION - Follow up: a. Final lab results often come in after the mother and infant have discharged. b. In the case of the NICU infant, the NICU staff will inform the parents of feeding plans based on toxicology results. c. If the infant has discharged to home prior to a final result, the positive final results will be sent to the provider caring for the infant as an outpatient. 1. Non-CentraCare PCP’s for infants will: a. Be informed via Epic (CentraCare), and the FBC Social Worker/Case Manager of positive Cord STAT or urine/meconium toxicology final results. b. The FBC social worker and or Case Manager will report to public health and or social work, maternal and neonatal positive Cord STAT or urine/meconium toxicology results to County and PCP, according to state law for Non-CentraCare providers. 2. CentraCare PCP’s for infants will: a. Be responsible after final Cord STAT or urine/meconium toxicology results for infant are resulted and reported to them via Epic. b. Be responsible for public health and social work reporting of maternal and neonatal positive Cord STAT or urine/meconium toxicology results to the county according to state law. 3. The infant PCP across the continuum will communicate breastfeeding continuation recommendations to the mother/parents at their discretion.

VII. REFERENCES: National Guidelines/National Standards/Regulatory Breastfeeding and the use of human milk (2012). Retrieved 1/16/15: http://pediatrics.aappublications.org/content/115/2/496.full.html Breastfeeding: Potentially Harmful Substances and Disease Contraindications Page 4 of 4 Centers for Disease Control and Prevention (2012). Breastfeeding: Diseases and conditions: Hepatitis B and C infections. Retrieved 1/16/15: http://www.cdc.gov/breastfeeding/disease/hepatitis.htm The CDC’s Breastfeeding Report Card. (2014, July). Retrieved 11-6-2014: http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf The Surgeon General’s Call to Action to Support Breastfeeding. (2014, August 12). Retrieved 11-6-2014: http://www.surgeongeneral.gov/library/calls/breastfeeding/ and http://www.surgeongeneral.gov/library/calls/breastfeeding/calltoactiontosupportbre astfeeding.pdf

Literature Ball, O. (2010). Breastfeeding is a human right. Breastfeed Rev. Nov; 18(3), 9-19. Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827-e841. Gartner LM, Morton J, Lawrence RA, et al. (2005). Breastfeeding and the use of human milk. Pediatrics. (2005);115(2):496–506. Gillis, M., & Sigman-Grant, M. J. (2010). Principles of health care ethics and the WHO/UNICEF 10 steps to successful breastfeeding. Journal of human lactation: official journal of International Lactation Consultant Association, 26(1), 11. Hale, Thomas, (2012). Medications and Mother’s Milk (15th edition), Amarillo, TX: Hale Publishing Mohrbacher, Nancy (2010). Breastfeeding Answers Made Simple, A Guide for Helping Mothers. Amarillo TX:Hale Publishing

Book: Cadwell, K. (2008). International Initiatives to Promote, Protect and Support Breastfeeding. IN: Mannel, R., Martens, P., Walker, M. Eds. Core Curriculum for Lactation Consultant Practice. 2nd Ed. Sudbury MA: Jones & Bartlett, 2008, p 19- 32.

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