Supporting Breastfeeding in the Setting of Perinatal Opioid Use Disorder.

Studies have shown that many pregnant women with opioid use disorder intend to initiate breastfeeding after giving birth. However, continuation rates beyond the initial postpartum hospitalization are low. Achieving and maintaining an antepartum breastfeeding plan may be complicated by the unique challenges that opioid-exposed dyads experience after birth. Stigma, inconsistent messaging about the safety of breastfeeding while on opioid agonist therapy, and institutional policies that separate the dyad can contribute to low continuation rates. Additionally, neonatal opioid withdrawal syndrome may include gastrointestinal, musculoskeletal, and neurological symptoms that can lead to difficulty establishing breastfeeding. Neonatal weight loss may require temporary supplemental formula use. The safety and benefits of breastfeeding in the setting of opioid agonist treatment for perinatal opioid use disorder is well established in the literature. This case reviews the safety and benefits of breastfeeding in the setting of perinatal opioid use disorder and provides evidence-based strategies to support the feeding preferences of these families.