Many of us have already heard about the ill effects of smoking, either from our health care provider, relatives, or from different forms of media. So if you’re a mom who can’t quit smoking, you’re probably thinking whether you should still breastfeed your baby or not. To help enlighten your thoughts and guide you towards your decision, here’s what the latest research and experts say regarding this topic.
So what are the recommendations regarding breastfeeding and smoking? The American Academy of Pediatrics recently removed smoking of tobacco as a contraindication to breastfeeding. In addition, let’s take this statement issued by the Centres for Disease Control and Prevention:
“Using tobacco or e-cigarettes while breastfeeding can allow harmful chemicals to pass from the mother to the infant through breast milk or secondhand smoke exposure. Mothers who use tobacco or e-cigarettes should be encouraged to quit. Regardless, breastfeeding provides numerous health benefits and breast milk remains the recommended food for an infant.”
Therefore, breastfeeding is still the recommended source of nutrition for babies, regardless of whether the mother stops smoking or not. However, a mother who smokes and wishes to continue breastfeeding her baby must also be aware of the possible effects of nicotine. This includes how long she may breastfeed as well as the necessary measures she can take to at least minimize the effects of smoking on her baby.
Can smoking affect milk supply?
One of the first things that concerns a smoking mother planning to breastfeed is how it will affect her milk supply. It turns out that there are various aspects from which smoking can place a breastfeeding mom’s milk supply at risk. Specifically, these aspects are the following:
- Smoking reduces prolactin levels
There are several studies suggesting that the hormone prolactin is significantly lower among smokers when compared to non-smokers. Prolactin is a hormone produced by the pituitary gland in the brain and plays a major role in breast milk production.
Even during pregnancy, prolactin is already preparing a mother’s breast for milk production. Right after delivery, there will be a rise in prolactin production, and this surge is responsible for making a new mom’s breast engorged with milk.
Since it can reduce prolactin levels, smoking during pregnancy and while breastfeeding may result in a decreased production of breast milk.
- Smoking may increase somatostatin levels
Researchers from NCBI have found that somatostatin levels are generally higher among smokers than non-smokers.
Somatostatin is a hormone that inhibits the production of other hormones in the body. According to one study, it was observed that a higher milk production is often followed by a significant reduction in the somatostatin levels of the mother right after feeding. Since this hormone is observed to be higher among smokers, it is thought that it may result to a lower volume of breast milk produced by the smoking mom.
However, another study mentioned that the basis for this research is weak.
- Tobacco may increase the blood epinephrine levels
Some researchers say that smoking tobacco may increase the hormone epinephrine in the mom’s blood. Epinephrine causes vasoconstriction or the narrowing of blood vessels in the body and may also affect the vessels in the mammary gland. This constriction will then reduce the levels of the hormone oxytocin in the mother’s blood and disrupts the milk ejection or let-down response, which may affect the milk supply in the long run.
- Baby may have delayed the onset of suckling
There are some studies suggesting that babies born to a smoking mother may have delayed initiation of the sucking reflex and tend to have a lower sucking pressure. Since the breastfeeding hormones respond to baby’s sucking and breast stimulation, this delay may impact the mother’s breast milk supply later on.
- Smoking moms tend to be less motivated to breastfeed
Although the physiological effects of smoking or nicotine have been mentioned, we need to take into consideration other factors that may have an effect on a mother’s milk supply. A study by Amir and Donath (2002) found that psychological factors are the main reason why mothers feed less often and for a shorter period of time.
Continuous and frequent feedings are vital to maintaining a steady supply of breast milk. Some smoking mothers may feel concerned about the effects of nicotine on their baby and this may lead to a lower milk supply.
How does nicotine in breast milk affect a baby?
As mentioned, worrying about the effects of nicotine is one factor that makes a smoking mom less eager to initiate or continue breastfeeding.
Nicotine is a substance that is naturally found in tobacco plants. It is also present in some e-cigarettes and other nicotine replacement therapies. When tobacco smoke is inhaled, nicotine rapidly travels from the mother’s lungs to her bloodstream and then diffuses into her breast milk.
- Nicotine in breast milk may impact a baby’s weight
There are several studies suggesting that nicotine alters the composition and taste of breast milk. Experts say that this may lead to shorter and less frequent feedings and even negatively affect the baby’s weight gain. Specifically, these effects are as follows:
- lower fat content of the breast milk
- lower content of iodine, which is vital for brain development
- suppresses infant’s appetite
- lower vitamin C contents of breast milk
- breast milk tastes smokey or cigarette-like
According to some studies, nicotine in breast milk might make baby more colicky, irritable and sleep less if mothers smoke more than 5 cigarettes per day. The change in baby’s sleeping pattern is related to nicotine being a stimulant.
- High levels of nicotine is linked to certain health risks
A mother smoking 20 or more cigarettes a day may yield a high nicotine content in her breast milk. This is linked to some gastrointestinal problems like nausea, vomiting, and diarrhea. Being a stimulant, it may also increase the baby’s heart rate. Some experts say that increased nicotine levels in breast milk may affect the normal lung development of the baby and places him at risk for childhood obesity and problems with thyroid functioning.
Though the effects of nicotine in the breast milk may appear serious, experts suggest that the benefits your baby can get from breast milk still outweighs the risks. Breast milk provides live good bacteria, certain enzymes and immune factors that can’t be matched by commercial milk varieties. Experts also suggest that when bottle-fed, babies have an increased risk to certain conditions due to passive or 2nd hand smoke if the mother or any of his household members smoke. Since breast milk provides extra protection for babies, this makes breastfeeding and smoking better than bottle-feeding and smoking.
So if you’re breastfeeding your baby whilst smoking, there are ways to help minimize the negative effects of smoking to your baby. Remember, even if it’s not contraindicated, too much exposure to nicotine via breast milk and 2nd hand smoke poses risks to your baby. The following points will help keep your baby limited to the exposure of the chemical contents of cigarettes while breastfeeding.
How long do you wait to breastfeed after smoking a cigarette?
It has been observed that there is a significantly lower nicotine level found in mom’s breast milk when there is a longer interval between smoking and breastfeeding. Thus, the longer the time you wait, the less amount your baby will be exposed to nicotine which is then diffused into your breast milk.
While you smoke, nicotine is immediately absorbed into your bloodstream and transferred to your breast milk. This means nicotine will be at its highest concentration in your breast milk right after you have smoked. Studies suggest that the levels of nicotine in the mother’s blood and milk decreases to half after around 90 minutes.
Additionally, the carbon monoxide that you exhale is significantly higher on the 1st hour after smoking, making it less ideal to come near your baby during that period of time.
Some experts suggests that after smoking, wait at least 3 hours (the longer, the better) before breastfeeding your baby. Since a newborn baby nurses frequently during the first few weeks and breastfeeding more often even helps in increasing your milk supply, you might find it hard to follow the longer interval rule. So most lactation experts advise to smoke right after you breastfeed your baby. This will allow a longer period of time for nicotine levels to decrease in concentration in your bloodstream and breast milk.
Should I pump and dump after smoking a cigarette?
Pumping is a method of expressing breast milk via manual or electric pumps. This is often done to relieve pressure from engorged breasts, remove excess milk due to baby’s incomplete feeding and to continuously stimulate mom’s breasts to produce a steady supply of breast milk. In most cases, the pumped milk is stored in the refrigerator or freezer for baby’s future consumption. However, there are some instances where pumped breast milk should be discarded as it was either contaminated or mom has taken substances which can be harmful to her breastfeeding baby.
If mom smokes while breastfeeding, nicotine and other chemicals present in the cigarette can be transferred to breast milk. There is no benefit to pumping and then discarding your breast milk after smoking a cigarette. Instead it is recommended to smoke right after you feed your baby.
Studies have revealed that the amount of nicotine the mother consumes will accumulate over a 24 hour period. This means that even if you pump and dump right after, smoking more frequently would make your bloodstream and breast milk more concentrated with nicotine which could be harmful to your baby.
Does nicotine stay in pumped breast milk?
With one puff, the nicotine content of tobacco can rapidly cross from the lungs into the bloodstream. Studies have found that it accumulates in the breast milk of the smoking person. The amount of nicotine in the pumped breast milk will be determined by what time the breastfeeding mom had a cigarette. So, if you want to pump and store your breast milk, it is better to follow the general recommendations and pump before you smoke a cigarette. Doing so will ensure the concentration of nicotine in your breast milk will be at its lowest while you pump.
Alternative Forms of Smoking while Breastfeeding
As more people are becoming aware of the damaging effects of smoking as well as it being banned in many public places, alternative methods other than the cigarette are more commonly being consumed. Cigarettes now differ widely in their tobacco concentrations and alternatives include e-cigarettes, vapes or shisha. Let’s take a look at some of the most commonly used methods and how they can affect you and your baby while breastfeeding.
- Smoking herbal cigarettes while Breastfeeding
Herbal cigarettes are the ones being marketed as tobacco-free or nicotine-free. This type of cigarette is made from a mixture of herbs, flowers and other natural ingredients.
Due to them being labeled as natural with no tobacco content, breastfeeding mothers may tend to think of them as a “safer alternative” to the regular cigarettes. However, there is no actual proof that this may be the case.. An article from NBCI states that there is no published literature available to verify claims that it reduces harm. When burned, the herbs produce many of the harmful chemicals released by burning tobacco, such as tar and carbon monoxide.
Smoking herbal cigarettes while you’re breastfeeding your baby or smoking it anywhere near your baby is not safe. Carbon monoxide can increase the risk of Sudden Infant Death Syndrome or SIDS is babies. Just like when you are smoking your regular cigarette, you will continuously release carbon monoxide as you breathe. This makes it less ideal for you to sleep next to your baby.
- Smoking light cigarettes while Breastfeeding
Light cigarettes are those that are being marketed to have lower tobacco or chemical content when compared to regular cigarettes. Sometimes, you may find them labeled as “low-tar” or “mild”.
Similarly, these labels may attract more smokers, especially those who are trying to decrease their exposure to nicotine like breastfeeding mothers. However, experts say there is no scientific basis on the claim that they are less dangerous. In fact, the US Food and Drug Administration banned these labels from the cigarettes being released.
While breastfeeding, it is still safer to decrease the frequency and amount of cigarettes you smoke and follow the general recommendation of smoking just after you breastfeed rather than rely on the label on the cigarette.
- Smoking E-cigarettes while Breastfeeding
Electronic cigarettes or e-cigarettes are battery-operated devices that produce an aerosol made out of a mixture of nicotine, flavorings and other chemicals. Most e-cigarettes work with the same concept. There is a cartridge that holds the liquid or juice where it contains different amounts of nicotine or other artificial ingredients. When the person puffs, the heating element of the device, called the atomizer, is activated and vaporizes the juice in the cartridge. She will then inhale the resulting vapor that has been produced.
There is a wide variety of e-cigarettes when it comes to their designs and some e-juices are labeled as nicotine-free. This makes them attractive to the younger population and adults who may want to make it a stepping stone to quit smoking. However there are some studies showing that teens who haven’t smoked before using e-cigarettes, resulted to smoking actual cigarettes later on.
Likewise, if you’re a breastfeeding and thinking about e-cigarette as an alternative to regular cigarettes, you might want to think twice. According to some experts, though some e-liquids are marketed with no nicotine, they comprise of a number of other chemicals which are yet to be studied. As their effects are unknown there may be a chance they might be harmful to you or your baby. Following the general precautions on smoking while breastfeeding is best even when you are using e-cigarettes.
- Smoking Vape while Breastfeeding
Vapes are devices that work very similar to e-cigarettes and are marketed with a wide variety of designs like vape pens and MODS or the advanced personal vaporizers. Vaping involves inhaling and exhaling aerosol which contains varying amounts of nicotine, flavoring and chemicals from which some might be hazardous to you and your baby’s health. However, manufacturers report that the chemicals found in vapes are less in number than the almost 7000 chemicals found in cigarettes. More research is needed to firmly establish whether vapes are safer alternatives to cigarettes and if you are currently breastfeeding, it is better to follow the general precautions as if you were smoking cigarette.
- Smoking JUUL while Breastfeeding
JULL is a modern variety of vapes which resembles the design of a USB flash drive. The small and subtle design makes it very popular to the younger generation because it can easily be hidden. It works in a similar way to most vapes but according to some experts, users have to watch out for the nicotine content of this product. There is one source saying that one pod of JUUL has a nicotine content similar to a whole pack of cigarettes. So if you’re a breastfeeding mom who has been using JUUL as a smoking device then it is better to take extra precaution and consult a health care provider. There is a risk you may have been exposing your baby to a larger concentration of nicotine, both via breast milk and 2nd hand smoke.
- Smoking hookah/shisha while Breastfeeding
Hookah is a smoking device which involves the use of a water pipe and some charcoal to burn a mixture of tobacco called shisha, along with some flavors. Smoking hookah has been popular in bars and social gatherings where smokers can pass around the mouth piece while spending time together.
Smoking hookah or shisha while breastfeeding can expose you and your baby to similar risk when you are smoking cigarettes. The burning charcoal itself emits carbon monoxide that is harmful for babies. Its therefore better to keep a distance from your baby or better yet, use your hookah outside of your home to minimize your baby’s exposure.
Some of the modern varieties of hookah makes use of steam stone instead of charcoal and tobacco to produce vapor, and some are marketed as hookah pens which works similar to e-cigarettes. Still, more research is to be conducted with regards to the safety of these devices, especially when it comes to breastfeeding mothers.
- Edibles/ Chewing Tobacco vs. Smoking while Breastfeeding
Chewing tobacco is also known as smokeless tobacco. As the name suggests, the tobacco leaf or plug is placed in between the check and gums and the person using it needs to chew it in order to release its nicotine content.
Since it is smokeless, some mothers may think of it as a safer alternative to smoking while breastfeeding. However, if you chew tobacco, you will ingest nicotine along with other chemicals and these can also be transferred into your breast milk. Experts suggests that even if it may pose less risk when compared to smoking, chewing tobacco is still hazardous to you and your baby.
- Breastfeeding while Smoking Crack
A crack is a form of cocaine, a recreational drug which came from the leaves of a plant called coca. The term “crack” came from the cracking sound it creates when the water vapor is released. Crack is a highly addictive drug that can alter your psychological and physical well-being. This is the reason it is banned or marked as illegal in most countries.
Breastfeeding mothers should never smoke crack, especially if their infant is in close proximity. It is known that cocaine and its metabolites can transfer via breast milk. Newborn babies are highly sensitive to this drug since their bodies have not yet created the enzyme that can inactivate it. Infants that are exposed to cocaine through breast milk have been reported to manifest serious adverse reactions.
If you’ve used this drug before and you plan to breastfeed, you might be wondering what you can do. The Academy of Breastfeeding Medicine’s recommendation is that women who have abused cocaine SHOULD NOT breastfeed UNLESS:
- She had a negative result on her urine toxicology upon delivery.
- She abstained from cocaine for at least 90 days.
- Into a substance abuse treatment program and will continue even after she gave birth.
- Gained the approval of their substance abuse counselor.
- She is compliant to her pre-natal check-up.
- She has no other contraindications to breastfeeding.
How to protect your baby from cigarette smoke and nicotine
It is important to note that there is no safe level of exposure when it comes to cigarette smoke and nicotine, especially in relation to babies. But if you smoke, you can at least lessen your baby’s exposure by following these recommendations:
- Smoke after you feed
As mentioned earlier, this technique is to provide breast milk with the least nicotine content to your baby and allow a wider interval between the actual act of smoking and your next feeding.
- Smoke as far away as possible
Apart from the nicotine ingested from your breast milk, you don’t want your baby to suffer from the effects of 2nd hand smoke and 3rd hand smoke (the ones which remains in the walls or furniture), right? Experts suggest you shouldn’t smoke in your car or inside your home even if you have opened the window or have fans around. Smoking outside of your home in an open area away from your baby is the best alternative.
- Cover up when you smoke
Since nicotine and other chemical particles can stick to your clothing, it is better to have a jacket or another piece of clothing to cover you up while you smoke. Remove this clothing before you go inside your home and go near your baby.
- Wash the exposed body parts
If you have just smoked, it is better to wash your hands, arms and face before you get in close contact to your baby to remove any particles that may be left.
- Educate your household members
If your other family members or any person who lives in your home are also smoking, they should also follow most of the precautionary measures mentioned above, especially when they come near your baby.
- Fewer smokes
The less frequent you smoke, the less nicotine will be present in your breast milk and the less harmful chemicals will be released in the air. Fewer smokes also means more time that you can cuddle and play with your baby and of course, better health for the both of you.
How to quit smoking while Breastfeeding
The best way to protect your baby from the harmful effects of nicotine and tobacco smoke is simply to quit. However, it wouldn’t be as simple as it may seem. Nicotine is an addictive chemical such that your mind and body will crave for it. Abrupt smoking cessation may also give you withdrawal symptoms. It is important to note that you’ll need to consult a professional to properly guide you on how to quit smoking while breastfeeding.
The most common option is nicotine replacement therapy (NRT) which involves the use of low doses of nicotine to lessen a person’s craving to smoke. The low-dose nicotine supplements may come in the form of lozenges, gum, inhalers, nasal spray or skin/ transdermal patch. These supplements doesn’t contain the other chemicals present in tobacco smoke.
If you’re a breastfeeding mother who is using nicotine gum or lozenges, treat it as if you are smoking a cigarette and chew it right after you breastfeed. On the other hand, if you’re using the transdermal patches, it is important to know that these patches provide a steady supply of nicotine into your bloodstream and breast milk. If you may not be smoking a cigarette in the evening, try removing the skin patches at night to reduce the amount of nicotine when you breastfeed your baby at night.
- How does tobacco smoke affect a developing baby?
Smoking during pregnancy can cause low birth weight, pre-term delivery, and infant death. According to the CDC, nicotine and other chemicals present in tobacco smoke can also damage a baby’s developing brain and lungs.
- Can smoking during pregnancy cause learning disabilities?
Experts say that smoking while pregnant could cause learning disabilities along with other health risks. There is also a study which revealed that smoking during pregnancy affects the speech ability of newborn infants.
- Can smoking while breastfeeding make baby fussy?
Smoking can make a baby fussy due to the effects of nicotine from his mother’s breast milk or aerosol. Nicotine is a stimulant which can increase a baby’s heart rate, disrupt his sleep pattern and make him more prone to colic.
Overall, the best way to protect your baby from nicotines potentially harmful effects is to decide to stop smoking. If you’ve done it while pregnant, there is a good chance you will continue to resist your smoke cravings now that you have your little one. But most importantly, no matter what your decision is, breastfeeding is still the best choice for your baby even if you are unable to stop smoking cigarettes.
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