EPISODE 60

Smoking Cigarettes and Breastfeeding

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Episode Transcript

June 04, 2021

Smoking and breastfeeding...is it safe?!

This is Maureen Farrell and Heather O’Neal. And this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

So join us for another episode. Welcome to another episode of The Milk Minute Podcast, everybody. Today, we’re going to talk about using tobacco while breastfeeding. Yeah. Not just tobacco, but the kind you smoke that also has other things in it. Yeah. So specifically, we’re gonna talk about smoking tobacco.

There are other ways to use this. I’m not really going to focus on them, but a lot of this is kind of applicable across the board. Right. But we got to show some love to our smoking listeners who are breastfeeding and, you know, we still want to celebrate your breastfeeding journey and also maybe give you some tools and information that you might need to know.

Yeah. Yeah. And I just really, my goal today is to cut out the shame. Yeah. Because we see a lot of, like every, like once a month or so somebody posts on our Facebook group, can I, you know, can I breastfeed while I smoke? Or not at the same time, you know what I mean? And inevitably I have to delete like 20 comments off of that post, because they’re mean. And I think there’s really a big difference between our perspective on this as healthcare providers and a lot of other people, like we really focus on harm reduction, understanding that humans are not perfect.

So sometimes the best that we can do in a situation is make it as safe as possible and then support those people if they’re ready in making a different choice when they’re ready. Right. Absolutely. And you know, best laid plans, right. You know, oh, I’m going to quit smoking before I get pregnant. Surprise, you’re pregnant and now they’re smoking and now you’re like hurrying up to figure out what you can do about it.

And now your whole life is stressful. You know, losing one of your coping mechanisms for stress is going to be a really hard thing at that point. It’s just, it’s not, it’s not always the practical solution to say, just stop smoking. Right. And you know I think that I’m recalling now as a kid walking with my family out in public and seeing someone, you know, either breastfeeding and smoking or smoking with a small child and my dad, love him so much, but he is like, I can’t believe she would do that.

What kind of parent would do that? It’s like, one with an addiction that also has, you know, no time to go exercise and cope in any other way. A normal person. Yeah. Like they’re not some kind of, millions of people. Right? Exactly. I mean, I had a really weird interaction like that with a friend of mine when we were walking by the hospital.

And there were two pregnant people smoking outside the door, you know, who maybe they were in labor, who the fuck knows? Like they were real pregnant though. And they said something really, really similar. And yeah, I came back at like, what kind of person would do that? A normal fucking person who’s dealing with substance addiction.

Who’s dealing with stress and who the fuck knows what’s going on in their life right now? Yeah. You don’t get to judge that. Yeah. But you know, I think we tend to focus on that aspect instead of, oh, wow look, she’s breastfeeding. Yeah. Good for her. Exactly. It’s not like, because you smoke it erases all the other great things that you’re doing.

No. So that’s what we’re here doing today. So just so everybody knows we are, we’re gonna keep this positive. We’re gonna really talk about facts, and we’re going to try to set some things straight. But before we do that, we are going to take a listener question. And then if you stick around to the end, we’ll have an award in the alcove.

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So today’s question comes from Steph Lynn in our Facebook group. She says, “what can I take for allergies? I’m visiting my in-laws for the week and their cats are literally making me insane.” Yeah. So first let me say what not to take. Please don’t take Benadryl. That medication is notorious for tanking supply, right?

And pretty much the rule is any allergy medication that has a D attached to it for decongestant is not going to be cool for supply because it dries up all your mucus membranes. And guess what? Your milk. Yeah. So usually we see for most people, the regular Zyrtec and the regular Claritin are okay.

Here’s the thing. If you are planning a visit with people with cats, you really need to start that before you go. Like a couple of weeks before you go, because once you’re starting to have a histamine response, it’s like a runaway train. And then you can really only get back to the baseline of where you were to start with when you had the reaction.

So we really want you to start taking that medication before you go to lower the set point of reaction. That way you’re normal the whole time, not just like mildly irritated the whole time. Right. And if it’s possible, like if the people you’re visiting are nice and consider it, talk to them about it and be like, Hey, I’m breastfeeding.

You know, I’m allergic to cats. It’s really hard to take allergy medication while breastfeeding, you know, can you vacuum the guestroom and wash all the linens and just shut the door so the cats can’t get in? So I at least have like one place that I don’t have to deal with allergies or like really. You know, my dad is allergic to cats.

We have cats, I basically vacuum and wash every single fabric surface in the house before he comes, even though, you know, like, yeah, it takes a whole day, but also that has to get done at some point anyway. So I’m like, all right, just taking this opportunity to do kind of a deep clean. Yeah, that’s a really good idea.

And also if they’re not willing to do that, maybe you’re not willing to change your life, to go visit them, to deal with your histamine reaction. Like, oh, I’d love to come visit, but I really don’t want eyes the size of golf balls the whole time I’m there because of the swelling. It doesn’t really sound like a very exciting time for me.

Yeah, but anyway, good luck with that. I hope those meds work out for you.

Right? Right. So we first want to mention that this episode is strictly informational and there is no judgment here, but there are some things we definitely need to cover. And I also want to say everybody’s situation is unique. So we’re going to talk about a lot of recommendations in general, not everything might be applicable to you, you know, and, and that’s okay.

You might not be ready to take some of the recommendations we’re giving, but please talk to your healthcare provider about that. Right. So we just want to clear the air on the most recent recommendations, because there is an old recommendation that if you are a smoker, you should not breastfeed and that is changed now.

So we, we definitely want you to know that if you have a grandma or a maternal figure or somebody in your life who is saying that you can’t breastfeed because you smoke, they are incorrect. Yeah. So I’m pretty sure it was in 2001, the American Academy of Pediatrics removed nicotine from its list of contra-indicated substances while lactating.

Yeah. And that’s really important because we are seeing so many more health benefits for not just baby, but for the parent, the birthing parent and lactating parent. So a couple of things that might happen to you, if you are a person that smokes pretty heavily in pregnancy. Yeah. We just want to kind of lay out reasonable expectations, because if you’re using tobacco products, if you’re smoking regularly, lactation is probably going to look a little different for you. Right.

And we want you to be aware of these things so you can move past it, you know, just get over that hump so you can get back to normal. So first of all, nicotine is a vasoconstrictor. So that means that it makes your blood vessels get smaller. And that happens pretty quickly. So when you take a hit off of a cigarette, that nicotine is hitting your bloodstream pretty fast, which is why people love it, because it immediately makes you feel a little bit more relaxed and, you know, makes you feel good.

And just like with chronic stress, this vasoconstriction can have a long-term effect on milk supply because it affects your let down reflex. So just like if you were to put a bunch of ice packs on your boobs before you feed it’s constructing those vessels, which makes it really, really hard to get that milk out.

And when that happens over and over and over again, you will see a decrease in supply by proxy from that. Right. So in, in populations of people who smoke tobacco and lactate overall, we see a shorter duration of breastfeeding and we see more issues with milk supply because of this one thing, right?

Because you’re less likely to keep breastfeeding if you’ve got chronic low supply, if it’s really difficult for you to have a letdown. And again, it’s really all down to that vasoconstriction. And something else that we see a lot is, and this is hard to talk about, but it’s very important and we need to have an open and honest conversation about this.

Nicotine is one of those things that babies can withdraw from after birth, if they’ve been exposed to a lot of it in utero. So if you’re at least a pack a day person while you’re pregnant, your baby is getting exposed to that and they can withdraw from it after birth. You know, and that can look like irritability that can look like popping on and off the breast cause they can’t neurologically get themselves, put together enough to feed.

And a lot of times these parents are thinking this baby doesn’t like my boobs, this baby hates my breasts milk. And especially if you’re already in a situation where a bunch of people have told you that you’re a bad person for smoking, that really doesn’t set you up for any kind of success with lactation.

Right. And, and then to have a baby that’s difficult to console and feed on top of that is really hard. Yeah. So we just want you to be aware of it so you can push through it because that will end with baby, you know, and when that ends, you want to be able to still have the option to breastfeed.

And if you stop right as soon as things get really hard when that withdrawal hits its peak and it happens, you know, three, four days. Yeah. It’s really in that first week of life. And, you know, we see this with a lot of substances and other medications too, that people were taking in pregnancy. And again, it doesn’t make you a bad person and it’s not a reason to stop breastfeeding.

It’s just something that you need to be aware of and be prepared for. So extra grace and love for yourself and your partner, as you were trying to get through that first week postpartum, because some of the other substances that we see in those withdrawals, they might not even start until seven or eight days out, whereas smoking and nicotine withdrawal happens pretty soon.

So, you know, even if you’re a person that takes a different substance, in addition to nicotine, if you see a baby at 24 hours postpartum, and they’re already getting like a little tremory and irritable, that’s probably the nicotine more than anything. Especially, you know, most people are not smoking as much as they usually would during labor or during their hospital stay.

Even if they’re getting a nicotine patch or something, you’re not really at your normal intake level. So even though some of that nicotine is going to pass through breast milk, it’s not going to be the same amount baby was getting in utero. So, you know, hang in there through that time and really understand that that will end.

And it’s just a hump. That’s it. Surround yourself with supportive people. I have seen instances where partners are not supportive or mothers-in-law aren’t. Even, you know, there’s a shitty nurse on duty who makes one, you know, awful comment at 2:00 AM and that just sticks in your head.

You already feel like, oh, I couldn’t quit smoking while I was pregnant so I failed. And now look, I’m failing at feeding my baby too. Addiction is a really difficult thing to deal with. It is a disease. It is not a choice. And we fully support you wherever you are in that process. Whether you’re at a point where you say, you know what, reducing my smoking is not going to happen right now.

We’re just going to mitigate risk. Or if you’re at the point where you say, wow, I feel great and supported and I’m totally ready to work on that. Yeah. Like I don’t ever recommend cutting out everything all at once. So if you’re in the process of leaving an abusive partner, also not a great time to stop smoking. I mean, there are so many things, right.

If you’re, you know, if you’re three weeks postpartum and you haven’t slept more than a half an hour at a time, that’s not going to be an ideal time to reduce your tobacco intake or at least to stay to a really solid plan. I mean, you can always try to reduce it any time, but let yourself off the hook a little bit and understand that it is a process.

And we just want you to move in a healthy, positive direction for yourself in an attainable way so you don’t compound shame cause that’s terrible. And I want to do some kind of big picture reassuring and explaining for why organizations like the AAP would recommend that people who smoke breastfeed.

Right. I think it’s important to understand conceptually because a lot of folks look at that recommendation and they think, oh, like, why it’s obviously not good for baby. Yeah. You know, we don’t want to add nicotine to breast milk for no reason. Right. But here’s the thing. Infants of people who smoke, whether, you know, the lactating parent is the smoker or somebody else in the household.

They’re at an increased risk for different health issues. They’re at an increased risk of colic, respiratory infections, sudden infant death syndrome, asthma, et cetera. However, breastfed infants are at a lower risk for all of those issues compared to formula fed infants. And what we see is that the risk of having some chemicals from that tobacco smoke in breast milk is way outweighed by the benefit of giving that breast milk to these babies.

Absolutely. Yeah. So just to repeat that, breastfeeding and smoking is less harmful to baby than formula feeding and smoking. Yeah. That was much simpler. Thank you, Heather. Yeah. And that’s really important, like we said, and we’re going to keep saying this.

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All of your life is about risk mitigation, right? Like we’re, we’re just living in a harm reduction world because nothing we do is going to be completely safe. Right. It’s all about understanding risk and weighing risk and benefit. In so many different areas, so many different ways, guys, this is not just about smoking.

We talk about this all the time. Somebody is on their seventh cup of coffee right now. Right? Are you talking to me? We might be talking to you. It’s fine. We might be talking to someone who’s thinking about getting a tattoo while breastfeeding. We might be talking about someone who’s literally just getting in the car.

That is a big risk to your life, you know? Yeah, we just, our main goal is to help you be as safe as possible and that doesn’t just mean for today. That means for 10 years from now, which brings us to our next point, which is breastfeeding is just as beneficial for the smoking parent as the non-smoking parent.

Right. So. You know, we talk about this all the time. Like, oh, if you lactate, you know, it’s so healing for your body in the postpartum, and it helps you reduce your risk of all these cancers and blah, blah, blah. That’s still true if you’re a smoker. Especially, you know, especially when you’re at an increased risk for cancer because of smoking.

Yeah. So, you know, and also all those new studies are showing that it decreases your risk of developing type two diabetes later in life, which, and even heart disease. I mean like which smoking sets you up for those diseases, but breastfeeding can be healing in a lot of ways. So breastfeeding is a way of mitigating that risk of being a smoker in the first place.

It’s so important guys. And this is like, you know, when people gripe about, oh, exaggerating the benefits of breastfeeding, I’m like, you really can’t though. You can just say it in a nasty way. The thing is, it really is that great. It really is about the presentation though. Right? Be strong, be strong and firm in your stance.

You know, I think, it’s not like, what drives me crazy is it’s like, oh yes, breastfeeding is so beneficial for women. And like all of these things it can reduce risk, but not for you smoker, you don’t get to have that. No, that’s not okay. Yeah. We’re not, we’re not dealing with those people. So you, everybody deserves to have that level of health maintenance by breastfeeding. Everybody period.

Yep. Okay. So can we quick take like a scientific segue here into some of the nitty gritty about like nicotine and breast milk and times and amounts and toxins and blah, blah, blah. Let’s dive in. Yeah. Okay, great. I’m just going to say, of course, as usual, I’m looking at the¬†LACT med website. I am going to beat you over the head with the LACT med website, because it’s my best friend.

I don’t have to go on it anymore cause Maureen does all the time. Okay. So we pretty much only have information, like real studies on nicotine in breast milk from smoking and not from the nicotine replacement products. So disclaimer: don’t know how those play into this. Although let’s quickly mention that if you are looking to cut back, that is a good thing to do because you are limiting exposure to baby via your milk or through the air in some way.

So obviously, you know, if you’re currently smoking a pack per day and you cut down to five cigarettes a day, that’s limiting the amount of cigarette smoke in the air and on your clothes. So that is going to be beneficial. If you can cut back and you’re in a place in your life where that’s possible.

So even like decreasing it by one cigarette a day is a win. So hang in there. Okay. So nicotine. Now let me just say, of course there are a lot of other toxins in tobacco. But how much is really inconsistent, depends on pesticides and how it’s grown and how it’s processed. So we’re really just going to focus on nicotine.

I’m sorry that I can’t go over absolutely everything with you. Unfortunately, there are other toxins, there are their concerns, but this is going to be our main one. Yep. We’re going to stick to the nicotine talk. So studies indicate that the amount of nicotine found in breast milk is actually 2.9 times greater than that in maternal blood plasma.

Yeah, not a super fun fact. I did not know that. Right. So, and we do then see it present in the urine of infants who are breastfed by smoking parents. And it is greater, that level of nicotine is going to be greater, than for infants who are bottle fed with formula and just exposed to second or third hand.

Smoke. So, yes, we are seeing more nicotine in breastfed infants of smoking parents. However, like we said, the benefits still outweigh the risk for that. So knowing that let’s talk about how do we make the best of this situation. Yeah. How to do it properly. If you will, if you’re going to smoke, let’s do it the right way.

So the half-life of nicotine is about two hours. Half-life means the approximate time that it would take your body to metabolize half of the total amount of that chemical. So in two hours after smoking, you’re going to have half the amount of nicotine in your body. Right. Which is why, if you’re going to smoke, we recommend smoking after breastfeeding, because that’s going to reduce the amount of nicotine in the bloodstream.

Because like I said before, nicotine gets in your bloodstream really quickly. So this rule typically applies to alcohol as well. So alcohol and smoking and medications, we always say either, either do it right before or right after, but the key for smoking tobacco is after, because there are other factors we need to mitigate, not just nicotine in breast milk. Because with alcohol, we’re like, oh yeah, have a beer while you’re breastfeeding baby.

Do not, you know, but, but that’s different with smoking because we, we really want to protect baby from second or third hand smoke, and let’s be clear about what those are. So secondhand smoke would be smoke that your baby can inhale in the air that you have already exhaled. Or that is coming off of your cigarette.

And I think like, you know, a lot of us who grew up in the eighties and nineties, like we really got hit hard with the secondhand smoke campaign. Remember being at Wendy’s and the smoking section that was just like, not what is this hokey? But like, we all had that like education that like a lot of education on it in school.

Oh yeah. You’re talking about the education. We all got hit hard with it in a couple of ways. I mean, we weren’t quite on the same level. I mean, maybe some people were, but like my mom always talks about how my grandma would smoke a cigarette with her in her lap. Like that was their special time together. Yeah. I think by the time we were kids, though, there was a big public campaign against that.

So I think a lot of our listeners are pretty aware that secondhand smoke is harmful, but what we don’t talk a lot about, unless you have an infant, is third hand smoke. That’s a whole thing. Third hand smoke is the residue left on your skin or clothing after smoking, right. Which is why my dad always used to make my grandma put her coat in a special place, not in the coat closet.

Cause he really, my dad’s getting a lot of room time in this episode, he’s really bothered by cigarette smoke and he hates it. Which is understandable. But you know, he would be like, Florence, you need to keep your coat in a special area and she’d be like, okay, Steven. Anyway, though. So I want to talk about what that means practically for you.

Obviously we’re not going to be smoking in the same room as baby or we’re going to be smoking as far away from baby as is practically possible, whatever situation you’re in. But with the third hand smoke, what we’re going to do, like Heather said, if you can, have a smoking jacket, right? Big coat covers as much of your skin and clothing as possible.

That you can put on to smoke, take off when you’re done. You also want to wash all of your exposed skin after smoking, but before touching baby. So that’s kind of why I’m like, yeah, I get that long sleeve coat, right? So you’re going to wash your hands, your forearms, and really your face, your neck and your chest if they were exposed because baby’s face is all up in your neck and your chest.

And we just do not want them to absorb that through their skin. I don’t think a lot of people realize that we absorb things into our skin. So much. I mean, even the lotion that you put on your skin, those, the particles in that lotion get into your bloodstream in 26 seconds.

Like it happens pretty quickly. Our skin is not impervious. It’s actually meant to bring things in as well as let things out. Yeah. And, and, you know, like I know that this sounds like a lot to do, but you really just incorporate it into your ritual. Because for a lot of people, smoking it, you know, kind of half of what this does for them is provide a ritual of stress relief where you take a break and you go outside and that’s like, part of the reason it’s so hard to quit sometimes because you’re like, wait, where’s my seven minute break that I get every two hours and I really need? So try to incorporate that into your ritual, like get a jacket you like, you know, a cute polka-dot one or whatever makes you happy.

That also is easy to wash. If you can. And get some soap that you love the smell of and, you know, just make that washing like an act of self-love. Hmm. I like that. Yeah. In fact, maybe every two hours, I’ll set an alarm just anyway, to show myself some love. Just to wash your hands and put on some nice lotion after, you know.

Yeah, absolutely. Like there’s this doesn’t have to be an act of shame and self-punishment. Yeah. Which it, which it definitely can be. I can totally see how someone will be sitting there, washing their hands, hating themselves. No. Love yourself for doing this and congratulate yourself for creating a safer environment for your baby.

Yeah. So if you can do all of those things, as well as understand some of the hurdles that may come with being a smoking breastfeeding parent, you’ll be fine. But you know, there was another thing we wanted to mention is that nicotine can actually interfere with prolactin, which is the hormone that is used to stimulate the milk production.

So, you know, we have these milk making cells, but the prolactin is what tells them to do their thing. Right. And on top of that, smoking and having nicotine in your breast milk, we statistically see infants that sleep less. Right. I mean, and that’s, it’s one of the, it’s like a bad cycle, right? Cause you have this baby, that’s not sleeping, so you’re not sleeping, so you’re stressed.

So you smoke and then you breastfeed and then it puts more nicotine in their system and then they don’t sleep and then you don’t sleep and then you’re stressed and then you smoke. So understanding that cycle that, that might happen and expecting that you might have to be more vigilant in making sure you’re putting baby to breast every time. And if you can’t, then definitely pumping on, you know, regularly interval times.

You might just have to be a person that does that in order to combat that interference with prolactin. Yeah. And, you know, I think, I think it’s a good time right now to say since, you know, we’re, we’re really trying to be encouraging here is that if you do feel like you’re in a place where you can cut back, every single little bit makes a difference.

You know, if you’re using a nicotine replacement product, if you’re able to literally smoke one half of a cigarette less than you did yesterday, these are not futile acts. These are important for you and your baby. And it’s not shameful if you can’t do them. But if you do manage to do them, like give yourself some credit.

Absolutely. Yeah. And, you know, we do recommend the patch or the gum. They’re fine with breastfeeding, you know? So for those of you that are wondering like, oh, can I still breastfeed with the gum or the patch? Yes, absolutely. And that’s still a better alternative than smoking because like Maureen sort of mentioned before, there’s extra stuff in cigarettes that they put in there.

There’s toxins in there that we’re not talking about today, but could potentially have an effect on you as a person, as well as your baby. So, you know, the least amount of products in whatever you’re taking, the better. Right. And if you’re going to be using more of those replacement products that don’t produce second and third hand smoke, that automatically is just providing more health benefits for you and baby and everybody else you live with. So, you know, we’re just thinking about you all and we wanted to make sure you had an episode that you could count on. All right. Let’s head over for an award guys. Yes.

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Well, we hope that episode helped you, but before we go, we have an award to give. This week’s award goes to Lauren from our Facebook group and. Lauren has made some amazing strides in reducing how much formula supplementation she has to use with baby. She says that her baby usually drinks 24 to 28 ounces of formula per day.

But yesterday, she spent the time doing round the clock nursing and only had to supplement with 15 ounces of formula. Amazing. Yeah, she says so far today, we are only at eight ounces of formula and she said, this has been a long 10 weeks working on my supply, but she stuck to it and it’s finally working.

So we’re going to give you the Catch-up Queen Award. Heck. Yeah, we are. That’s amazing. And it is really, really hard to escape that top off cycle. So you’re amazing. Good job. We hope this inspires other people who feel like they’re just stuck in a rut. Those people that text us and they say, am I ever going to be able to exclusively breastfeed?

Here’s some proof you can do it. It’s in the pudding. All right, guys. Thanks for joining us today. And we’ll see you next week. Goodbye. Thanks for listening to The Milk Minute. If you haven’t already please like, subscribe, and review our podcast wherever you listen. If you’d like to support our podcast, you can find us on Patreon at¬†Patreon.com/MilkMinutePodcast.

To send us feedback, personal stories, or just to chat, you can send us an email at [email protected]

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