Breastfeeding and Methadone Therapy: The Maternal Experience

ABSTRACT

Background: Despite evidence of low transfer of methadone into breast milk and the potential physical and psychological benefits that breastfeeding offers for methadone-exposed mothers and infants, the rate of breastfeeding initiation in this population is about half that reported nationally. This study describes the perceptions surrounding breastfeeding decisions and management among pregnant and postpartum women taking methadone. Methods: Seven pregnant women and 4 postpartum women enrolled in methadone maintenance programs participated in semistructured, audiotaped interviews and focus groups, respectively, about their breastfeeding experiences. Transcripts were analyzed and coded using qualitative content analysis. Results: Three major content categories were identified: (1) fears, barriers, and misconceptions about breastfeeding while taking methadone; (2) motivation and perceived benefits of breastfeeding; and (3) sources of information, support, and anxiety about general breastfeeding management and breastfeeding while taking methadone. Lack of support from the health care community and misinformation about the dangers of combining breastfeeding and methadone therapy represented significant, yet modifiable, barriers to breastfeeding success in methadone-exposed women. Conclusions: Interventions to increase the prevalence of breastfeeding among women taking methadone should address identified logistical, educational, and psychological barriers and consider inclusion of women themselves, partners, peers, and clinicians. In particular, clinicians who care for methadone-exposed mothers and infants should be educated on therapeutic communication, up-to-date breastfeeding contraindications, and the health benefits of breastfeeding in this population.

Keywords:

• Breastfeeding
• methadone
• opioid-related disorders
• postpartum period
• pregnancy
• substance-related disorders

ACKNOWLEDGMENTS

The authors thank Martha Terry for her assistance in conducting the focus groups, Susan Zickmund and Judy Chang for their expertise in developing the interview guide, and Melinda Litzinger for transcribing the interviews and focus groups.

Funding

This study was funded in part by the National Institute on Drug Abuse (R21DA023263; Principal Investigator: Bogen), The Gerber Foundation, and Children's Hospital of Pittsburgh of UPMC Research Advisory Committee. Jill Demirci's contribution to the project was supported through a Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant (T32HP22240 HRSA NRSA for Primary Medical Care). No funding agencies were directly involved in the conduct of this research, including interpretation or composition of results.

AUTHOR CONTRIBUTIONS

Debra Bogen conceptualized the research question and design, participated in data collection, interpretation of results, writing and revisions. Yael Klionsky participated in data analysis and revisions of the manuscript. Jill Demirci was involved in data analysis, interpretation, writing, and revisions.