Breastfeeding and Methadone Therapy: The Maternal Experience

Objective:  Despite evidence of unique breastfeeding benefits for methadone-exposed mothers and infants, research suggests that breastfeeding rates in this population are less than half that reported nationally. The reasons for this disparity have not been adequately investigated. This study describes perceptions surrounding breastfeeding decisions and management among pregnant and postpartum women taking methadone. The results of the study are expected to inform the development of targeted breastfeeding interventions for this group.

Design: Qualitative content analysis using maternal individual interviews (during pregnancy) and focus groups (after delivery).

Setting: Recruitment and interviews occurred at an outpatient obstetrical clinic at a large, urban teaching hospital and a drug treatment program for pregnant women.

Sample: Seven women in their second or third trimester participated in individual interviews. Four women in their first year postpartum participated in one of two small focus groups. Women were 18-45 years old, prescribed methadone from a drug treatment program, and expressed an interest in breastfeeding.

Methods: Semi-structured, audio-taped interviews and focus groups were conducted by the PI.  Transcripts were analyzed and coded for major themes by each author independently and then compared.

Results: Motivating factors to breastfeed were similar to those described in the general population, but breastfeeding was also seen as a means to alleviate infant withdrawal symptoms. Some women experienced intense guilt about their methadone use and viewed provision of breastmilk and/or the physical act of breastfeeding as atonement to the infant. Pregnant participants wanted information about what to expect in the postnatal hospital course and expressed concerns about fitting breastfeeding into daily life, breastfeeding in public, the possibility that breastfeeding would be unsuccessful, and whether the infant could “overdose” on methadone or contract Hepatitis C from breastmilk. Postpartum women reported that nurses did not want to take the time to assist with breastfeeding or intentionally sabotaged breastfeeding efforts. For pregnant and postpartum participants, breastfeeding support was inconsistent. Information from peers was valued, but sometimes deemed untrustworthy. More prenatal and postpartum instruction was needed on breastfeeding mechanics, including pumping milk during infant separation. Participants suggested breastfeeding education include peer-support under the guidance of a knowledgeable professional, a discussion of breastfeeding benefits, and early “hands-on” breastfeeding assistance.

Conclusion/Implications for nursing practice: Healthcare providers who care for methadone-exposed mothers and infants should be educated on therapeutic communication, up-to-date contraindications to breastfeeding, the benefits of breastfeeding in methadone-exposed couplets, and basic breastfeeding interventions, including milk expression.

Keywords:  breastfeeding, methadone, substance-related disorders, social support, qualitative research