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methadone are present in breast milk, not enough to affect the baby.
Because of this, breastfeeding cannot be used to prevent or treat NAS.
It is important that a woman be stable in recovery if she plans to
breastfeed to avoid exposing the baby to drugs of abuse that may be
passed in breast milk.

In addition the woman’s HIV status and risk factors need to be
evaluated. HIV is passed in breast milk, so mothers infected with HIV
should not breast feed. It normally takes about 2 months from the time
of HIV exposure for the infection to be detected by testing. Mothers
who have tested negative for HIV but who have recent risk factors
must be counseled regarding the risk of transmission.

The mother’s hepatitis B and C status must also be considered.
Women need to be given information, so they can make an informed
decision. Traditionally, hepatitis B infection was considered to be a
medical contraindication for breastfeeding. Hepatitis B virus is
present in breast milk. Transmission from mother to child is most
likely to occur as a result of the delivery process. When a mother has
hepatitis B, the baby is treated at birth to decrease the risk of
transmission. The baby is given the first vaccination of a three shot
Hepatitis B series. The vaccination protects by stimulating the baby’s
immune system to make antibody that will attack the Hepatitis B virus.
It takes time for the vaccine to work, so the baby is also given
Hepatitis B immune globulin (HBIG). HBIG is ready-made antibody
that can begin fighting hepatitis B virus immediately. These
interventions decrease the risk of transmission via breast milk by about
95%. While Hepatitis C is not present in breast milk, it is present in
blood. According to the CDC, a woman with Hepatitis C may
breastfeed, but must discontinued, pump and discard in the event of
nipple trauma until she has healed.

Other Post-Partum Concerns

The methadone physician meets with the patient after delivery to
evaluate the methadone dose, screen for post-partum depression,
discuss the risk of relapse, encourage ongoing participation in the