Perinatal substance use

Drinking alcohol when breast/chest feeding can affect your baby's brain development, growth, and sleep. It can also decrease the amount of milk you make and how much your baby drinks during feeds. The safest choice is to not drink alcohol when breastfeeding and chestfeeding.

When stopping alcohol use or reducing it aren’t possible or wanted, there are ways to help reduce harm. For example, you can:

• Breastfeed/chestfeed your baby before drinking.
• Express and store milk before drinking.
• Wait for the alcohol to pass out of your milk before feeding. On average, you should wait 2 to 3 hours per drink before feeding.

While you wait for alcohol to clear from your milk, pump and dump your milk. Although this does not speed up the removal of alcohol from your milk, it is important to keep up your milk supply.

For more information

• Breastfeeding or chestfeeding - HealthLink BC
• Canada’s guidance on alcohol and health - Canadian Centre on Substance Use and Addiction
• Caffeine, smoking, vaping, alcohol, other substances and breastfeeding or chestfeeding (PDF) - Baby’s Best Chance: Parents’ handbook of pregnancy and baby care

Cannabis, in any form, passes into human milk and can be stored in your baby’s fat cells and brain. No amount of cannabis is known to be safe when breastfeeding and chestfeeding. The best choice is not to use cannabis when breastfeeding and chestfeeding.

When stopping cannabis use or reducing it aren’t possible or wanted, there are ways to help reduce harms. For example, you can:

• Choose a product with a lower amount of THC and use smaller amounts less often.
• Avoid synthetic cannabis products (e.g., K2, Spice) as these are stronger and more dangerous.
• Know where your cannabis comes from so you know it’s safe.
• Avoid combining cannabis with other drugs and alcohol.
• If you smoke, the safest place for your baby to sleep is in their own crib or bassinet, close to your bed. This keeps your baby safe and near you.

To protect everyone against second and third-hand smoke and vapour:

• Smoke and vape outside.
• Don’t smoke and vape in your vehicle.
• Wear a special shirt or jacket when you smoke and vape, take it off before going back inside. Hang it outside.
• Wash your hands and face with soap and water after smoking or vaping.

Talk to a health care provider to discuss all your options.

For more information

• Breastfeeding and cannabis: Things you need to know (PDF) - First Nations Health Authority (FNHA)
• Breastfeeding or chestfeeding - HealthLink BC
• Caffeine, smoking, vaping, alcohol, other substances and breastfeeding or chestfeeding (PDF) - Baby’s Best Chance: Parents’ handbook of pregnancy and baby care
• Canada’s lower-risk cannabis use guidelines - Government of Canada
• Cannabis - Northern Health

Using commercial tobacco or vapour products may negatively affect your baby’s sleep, growth, and long-term development. It may also impact your milk supply. The safest option is to avoid these products altogether. 

Breastfeeding/chestfeeding is still recommended for parents who use commercial tobacco and vapour products, as human milk may help protect your baby against some of the harms from smoking or vaping. 

For parents who smoke and vape, using less can help you feel better, stay healthy, and protect others from breathing in smoke and vapour. If quitting is not possible, try these steps to help keep your baby safe:

• Use less and/or less frequently.
• Breast/chest feed before smoking or vaping.
• If you smoke, the safest place for your baby to sleep is in their own crib or bassinet, close to your bed. This keeps your baby safe and near you.

To protect everyone against second and third-hand smoke and vapour:

• Smoke and vape outside.
• Don’t smoke and vape in your vehicle.
• Wear a special shirt or jacket when you smoke and vape, take it off before going back inside. Hang it outside.
• Wash your hands and face with soap and water after smoking or vaping.

Smokeless commercial tobacco products like snuff and chew don't make smoke, but they can still be harmful to your baby if you use them while breastfeeding. Talk to a health care provider to discuss all your options.

For more information

• Breastfeeding or chestfeeding - HealthLink BC
• Caffeine, smoking, vaping, alcohol, other substances and breastfeeding or chestfeeding (PDF) - Baby’s Best Chance: Parents’ handbook of pregnancy and baby care
• Canada’s lower-risk cannabis use guidelines - Government of Canada
• Smoking and commercial tobacco reduction - Northern Health

Many medications are safe when breastfeeding and chestfeeding. It is important to talk to your doctor or pharmacist to check for safety with any prescription or over the counter medications when breastfeeding and chestfeeding.

Some medications and herbal products are not recommended while breastfeeding and chestfeeding; in these cases, safe alternatives are available. You can feed your baby stored breast milk, donated breast milk, or iron-fortified formula. Keep up your milk supply by pumping and throwing away the milk.

For more information

• Check with your health care provider (e.g., doctor, pharmacist)
• Talk with a HealthLink BC pharmacist at 8-1-1 to learn if any medication, herbal product, or supplement you are considering taking is safe to take when breastfeeding and chestfeeding. Medicine use while breastfeeding – HealthLink BC

Unregulated substances include drugs like fentanyl, heroin, methamphetamine, crack, cocaine, benzodiazepines and many others. The current drug supply is toxic and unpredictable. This can increase your risk for overdose and other harms. Do not use alone and create a safety plan with friends and family to keep you and your baby safe. 

Some substances are safer than others when you are breastfeeding/chestfeeding. Safety depends on things like:

• What the substance is
• How much you use
• How often you use it
• How you take it

It also depends on your baby’s age, size and health, and your own health. Some substances can make it harder to breastfeed/chestfeed or take care of your baby.

For more information

• Caffeine, smoking, vaping, alcohol, other substances and breastfeeding or chestfeeding (PDF) - Baby’s Best Chance: Parents’ handbook of pregnancy and baby care
• Caring for your baby at risk of substance use withdrawal (PDF) - Fraser Health and BC Women’s Hospital and Health Centre
• Taking care: A short guide to breastfeeding and substance use (PDF) – Centre for Excellence for Women’s Health
• Find a harm reduction site - Toward the Heart