Pregnant or postpartum patients with history of substance use disorder who desire to breastfeed present healthcare providers with numerous issues as drug use increases risk for adverse health outcomes for both the mother and her child. Drug use in the U.S. is common. In 2013, an estimated 24.6 million Americans aged 12 or older were current illicit substance users representing 9.4 % of the population. This statistic unfortunately closely corresponds with substance use in pregnant women. Totally 9% of pregnant women used drugs during their first trimester. Substance use during pregnancy and during breastfeeding presents serious problem for the health of our society. When a mother with a history of illegal/illicit drug use or illegal substance abuse desires to breastfeed, her healthcare providers are faced with several ethical dilemmas. The most obvious is whether she should be allowed to breastfeed her child. Does the benefit of breastfeeding outweigh the risk of possible substance transmission to the infant or is formula feeding safer and more appropriate option for the infant? What is the consequence of formula feeding on the fragile relationship between the newborn and the troubled mother? Lastly, the infant’s right to be breastfed needs to be taken into consideration as a part of this complex issue. Healthcare leaders need to be able to understand ethical challenges of this specific population, acknowledge variances between individual substances, and most importantly differentiate between occasional drug use, diagnosable substance use disorder and treated substance use disorder. Healthcare leaders should be able to clearly identify how to best provide the most effective and supportive care. Changes to policies and healthcare practices can advance the overall health of this specific and challenging population as well as can improve the relationship between these patients and their healthcare providers.

Keywords: pregnancy; postpartum patient; breastfeeding; drug user; healthcare