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Breastfeeding in Special Situations

In special situations such as emergencies, during flu season, and when opiod use is involved, breastfeeding is the recommended method of feeding your baby. If your baby is born with special needs, there are also resources available to help your baby have a positive breastfeeding experience and increase their health outcomes.

Being knowledgeable and prepared ahead of time for these situations will make for an easier time breastfeeding for you and your baby in challenging or unexpected circumstances.

In this section, you will find breastfeeding information and tips on how to breastfeed babies with a variety of special needs, Oklahoma hospitals and speciality pediatric centers, and how to find milk banks to help with breastfeeding your baby.

Benefits of Breastfeeding Your Baby With Special Needs

 (shared with permission from La Leche League)

  • Babies with special needs (like prematurity, low birth weight, brain and nervous system conditions, cardiac problems or cleft lip/palate and babies who are ill) benefit from human milk even more than other babies.
  • Human milk boosts your baby’s immune system and is easier to digest.
  • It offers the perfect nutrition to keep your baby as healthy as possible, providing strength for any needed surgeries or treatments.
  • The special bond that breastfeeding provides and breastfeeding hormones help to keep you calm and more in touch with your baby.

Specific Special Needs Information & Tips

Pumping Tips

Hospitals with Breastfeeding Support for Babies with Special Healthcare Needs

Oklahoma City Tulsa Norman
  • Hillcrest Medical Center – Peggy V. Helmerich Women's Health Center 
 

Ascension St. John's Health System - Breastfeeding Support

 
   

Pediatric Specialty Centers in Oklahoma

Milk Banks

Mothers' Milk Banks screen donors and collect, process, and dispense donor human milk, which is prescribed by health care providers to help preterm and fragile infants thrive.

Oklahoma Mothers' Milk Bank (OMMB), located at 901 North Lincoln Boulevard, Suite 330, in Oklahoma City, partners with the Oklahoma Blood Institute and area hospitals to supply safe, pasteurized donor milk for preterm and fragile infants in Oklahoma, although requests from states without donor milk banks may be considered. 

Human Milk Banking Association of North America

More Resources

Oklahoma Breastfeeding Hotline
Línea de Oklahoma Lactancia Materna

  • 1-877-271-MILK (6455)
  • Text OK2BF to 61222
  • 24 Hour Toll-Free Breastfeeding Support Line for nursing mothers, their families, partners, expecting parents, and healthcare providers. All calls returned by an International Board Certified Lactation Consultant (IBCLC).

In an emergency, breastfeeding saves lives

In emergency situations, the safety net that breastfeeding provides is important. Research shows that infants are at higher risk for having diarrhea and other illnesses in an emergency. Babies who are breastfed receive a safe, reliable food source that protects them from these diseases. Supporting breastfeeding in non-emergency settings will strengthen the abilities of mothers and caregivers to cope in an emergency.

The Cleanest, Safest Food for Babies in Emergencies is Breastmilk

  • In an emergency there may be no clean drinking water or infant formula, refrigeration, or a way to clean bottles and nipples.
    • Nearly 95% of infant and child deaths in emergencies result from diarrhea due to unclean water and unsanitary conditions.         
  • Breastmilk is readily available and always at the right temperature.
  • Breastmilk is the perfect form of nutrition.
  • Breastmilk protects against infection and helps keep baby warm.
  • Breastfeeding helps calm crying babies and helps lower stress in the mother.

In situations where mother's own breast milk is not readily available:

  • The best option is pasteurized donor milk from a regulated milk bank
  • If formula is given, the ready-to-feed, standard formula is recommended
    • Only use concentrated or powdered formula if the water supply is safe

Breastfeeding and Emergency Preparedness Links

Oklahoma Breastfeeding Hotline

  • Línea de Oklahoma Lactancia Materna
  • Call 1-877-271-MILK (6455)
  • Text OK2BF to 61222
  • 24 hour toll-free breastfeeding support line for nursing mothers, their families, partners, expecting parents, and healthcare providers. All calls & texts returned by an International Board Certified Lactation Consultant (IBCLC).

COVID-19

Breastfeeding in Emergencies - National and International Resources

Benefits of Breastfeeding in Flu Season

  • Mothers provide antibodies to their babies through their breast milk.
  • Exclusive breastfeeding provides the most protection from the flu and other infections.
  • Breastfeeding mothers can safely receive the flu vaccine.
  • Babies 6 months and older should also receive flu vaccine.
    • FYI - Children aged six months through eight years receive 2 doses of flu vaccine at least one month apart the first year they receive the vaccine. Only one dose per year is needed after that.

Breastfeeding When Mother Has the Flu

Flu viruses do NOT pass through breast milk.

Guidelines for breastfeeding mothers who have the flu:

  1. Drink plenty of fluids.
  2. Rest.
  3. Wash your hands before touching baby.
  4. Continue to breastfeed.
  5. Before breastfeeding, wash breasts with mild soap and water.
  6. Wear a mask when nursing to prevent sharing the virus with baby and others.
  7. If you cannot wear a mask, avoid coughing and sneezing on baby and others.
  8. Use clean blankets or burp cloths for each feeding.
  9. Make sure that others who help to feed your baby follow above guidelines.

Breastfeeding When Baby Has the Flu

One of the best things you can do for your sick baby is to keep breastfeeding.

  • Give your baby many chances to breastfeed throughout the illness.
  • Babies who are sick need more fluids than when they are well.
  • The fluid babies get from breast milk is better than anything else - even better than water, juice, or Pedialyte® because it also helps protect your baby’s immune system.

If your baby is too sick to breastfeed, you will need to pump your milk so your baby can drink your milk from a cup, bottle, syringe, or eye-dropper. Talk with your doctor or health care provider if your baby is not drinking breast milk.

Breastfeeding and Flu Medication

  • Most flu treatments prescribed by your health care provider, such as Tamiflu and Relenza, are safe to take while breastfeeding.
  • Oral oseltamivir is the preferred antiviral treatment for pregnant women with flu symptoms and works best when started early.
  • For medication questions, mothers can contact their health care provider, doctor or pharmacist.
  • Mothers can also call the Oklahoma Breastfeeding Hotline at 1-877-271-MILK (6455) or text OK2BF to 61222 and talk with a International Board Certified Lactation Consultant (IBCLC) 24 hours a day, 7 days a week.

Additional Resources

Breastfeeding should be encouraged in women who:

  • are stable on their opioid agonist
  • not using illicit drugs
  • have no other contraindications (e.g. HIV+)

Common types of prescription opioid drugs are:

  • are stable on their opioid agonist
  • not using illicit drugs
  • have no other contraindications (e.g. HIV+)

Breastfeeding should be encouraged in women who:

  • are stable on their opioid agonist
  • not using illicit drugs
  • have no other contraindications (e.g. HIV+)
Common types of prescription opioid drugs are:
  • oxycodone (Percocet), hydrocodone (Vicodin), morphine and methadone.
 
Guidelines for using opiod drugs to treat pain in women who are pregnant or breastfeeding:
 
  • When choosing treatment for acute pain in mothers who are breastfeeding, non-opioid pain medicine like acetaminophen (Tylenol) should be used first.
  • Aspirin should be avoided, as it stays in mothers’ milk for up to 24 hours, and the newborn’s ability to break it down and get rid of it is slow.
  • Early breastfeeding by mothers who received opioid drugs during delivery results in little risk to the baby. However, breastfeeding babies will be exposed to any drugs taken by their mothers after delivery.
    • To reduce drug transfer to the baby through breast milk, medicines should be taken after breastfeeding if possible, to increase the time between taking the medicine and breastfeeding.
  • The amounts of codeine and morphine in breast milk are equal to or somewhat more than the mother’s amounts.
    • Because the absorption of oral morphine is very low, it can be given to breastfeeding parents.
    • Since experts are not able to predict which babies cannot tolerate codeine in breast milk, it should NOT be given to breastfeeding mothers.
  • Normeperidine (from Demerol) can pass into breast milk. Its half-life is much longer in newborns, so repeated use should be avoided.
  • Abruptly stopping opioid drugs that babies were exposed to in the mother’s womb can cause them to have withdrawal symptoms (trembling, irritability, excessive & high pitched crying, hyperactivity, tight muscle tone, sleep problems, seizures, poor feeding, vomiting, & diarrhea).
    • Breastfeeding should be encouraged in opioid-dependent mothers maintained on buprenorphine (Suboxone, Subutex): or methadone if there are no medical reasons to avoid breastfeeding with these exceptions:
      • urine drug screens positive for illicit drugs
      • positive HIV test
      • and/or other existing medical and/or psychiatric reasons to avoid breastfeeding
  • Health care providers should use caution when prescribing oxycodone (Percocet) to breastfeeding mothers, especially in the first two months after delivery. Oxycodone may cause the baby to be too sleepy and difficult to wake up.
  • Health care providers should refer to existing guidelines and consult with a substance abuse treatment provider.

Provider Resources

AAP POLICY STATEMENT: Breastfeeding and the Use of Human Milk

  • Adequately nourished narcotic dependent mothers can be encouraged to breastfeed if they are enrolled in a supervised methadone maintenance program and have negative screening for HIV and illicit drugs.

The Council on Patient Safety in Women's Health Care - Patient Safety Bundle on Obstetric Care with Opioid Use Disorder (+AIM) (addressing breastfeeding)

  • RESPONSE: Every provider/clinical setting/health system
  • Incorporate family planning, breastfeeding, pain management and infant care counseling, education and resources into prenatal, intrapartum and postpartum clinical pathways.
    • Provide breastfeeding and lactation support for all postpartum women on pharmacotherapy.
    • Provide immediate postpartum contraceptive options (e.g. long acting reversible contraception (LARC) prior to hospital discharge.

ACOG COMMITTEE OPINION: Postpartum Pain Management #742 2018
C:UsersnancybDownloadsACOG_Committee_Opinion_No__742__Postpartum_Pain.56.pdf

ACOG COMMITTEE OPINION: Opioid Use and Opioid Use Disorder in Pregnancy Number 711 • August 2017

ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015

  • Women on stable doses of methadone maintenance should be encouraged to breastfeed if desired, irrespective of maternal methadone dose
    • Reduced severity and duration of treatment of Neonatal Abstinence Syndrome (NAS) when mothers on methadone maintenance therapy breastfeed
    • Buprenorphine (Suboxone, Subutex): breastfed infants had less severe NAS and were less likely to require pharmacological intervention than the formula-fed infants
  • Opioid Agonist Pharmacotherapy = Medication Assisted Treatment
    • Prevents opioid withdrawal symptoms
    • Prevents complications of nonmedical opioid use
    • Improves adherence to prenatal care
    • Improves adherence to addiction treatment
    • Reduces risk of obstetric complications
    • Does lead to expected and treatable NAS in the infant

Healthcare providers and public health practitioners can find additional information at the CDC breastfeeding in special circumstances webpage.

For more information about breastfeeding in special situations, contact us:

Nancy Bacon, MS, RDN/LD, CDCES
Nutrition Consultant                       
Maternal and Child Health Service
Phone: (405) 426-8113
Fax: (405) 900-7580                             

Amanda Morgan, MPH, RDN/LD, IBCLC
Breastfeeding Education Coordinator
WIC (Women, Infant & Children)
Phone: (405) 426-8500
Toll Free: 1(888) 655-2942


Contact Information

Mailing Address:
Oklahoma State Department of Health
Maternal and Child Health Service
123 Robert S. Kerr Ave, Ste 1702
Oklahoma City, OK 73102-6406

Physical Address:
Oklahoma State Department of Health
Maternal and Child Health Service
123 Robert S. Kerr Ave.
Oklahoma City, OK

Phone: (405) 426-8113
Fax: (405) 900-7580