I am grateful for Tom Hale's informative and rational discussion of
recreational drug use involving marijuana.  In the absence of good data
describing long term sequalae of pre amd post-natal use of this drug, it is
difficult to know how to counsel mothers and child protective people who have
questions about its use in breastfeeding women.  My suspicion is that many
more women are recreational smokers than we guess, and due to risk of
hysteria or getting in trouble they don't even ask about it.  I often bring
up nicotine, alcohol and recreational drug use very briefly whether moms
bring it up or not.  I emphasize a factual rather than a judgemental approach
and discuss options to dose things if they are going to use.  I generally
mention having kids as an opportunity to examine behavior which has perhaps
been habitual, and mention community resources if people are interested in
making changes.

I saw Ruth Lawrence once field this question. She said she would rather see
pot using moms be encouraged to breastfeed (given the scarcity of evidence of
harm) so that they would have better infant bonding.  She, too,  feared these
moms would be very detached from their infants if they smoked and bottle fed.
 I agree.  Austin has the reputation of being a very "laid back" place.  The
60's are alive and well here, and I have had many acquaintences and clients
who have smoked marijuana while breastfeeding.  I don't defend this, but I've
always been interested and wished that there were some way to see if the kids
were affected. I've never perceived any noticable effect on infants, but then
what would such effects look like? Not that much can be extrapolated from one
example, but I know one family (acquaintances of my daughters) who have twin
boys.  the parents have probably used mj every day of their lives since the
60's.  They are kind of stereotypical --  he doesn't work much, everyone
plays a lot of guitar, etc.  But the boys are brilliant (National Merit
Scholars), cute, and very nice.  After some experimentation with mj
themselves in early teens, both elected to be drug free, tho they dress and
think very counter-culturally.  Both now in college and doing well.  The
mother is devoted to these boys, very good cook, and if anything
over-protects them.Dad is kind, non-abusive, involved with them in many
activities.  So while my worst concern to date is that pot using parents set
a bad role model for teens,  I have not particularly noticed detached
mothering styles due to  use of this drug. From what I've seen,  I think
detatched parenting and impairment is worse with alcohol use.  Probably any
chronic heavy use of mind-altering stuff is going to interfer with attending
to a child's needs. Any heavy cocaine users I've had contact with were the
pits as parents.

 Abuse of prescription tranquilizers produced the worse case of chronic child
neglect I've been intimately involved with . Due to maternal drug addiction
and depression this infant was weaned at 6 wk pp to Soy Moo -- a boxed soy
drink (parents believed formula was somehow un-cool.) Child was virtually
ignored all day while dad was at work.  Child is 12 now and seems either
mildly retarded or to be suffering from some sort of learning disability.
 can't function in school at all.  Very shy, poor eye contact. Lots of sad
feelings when I look at this girl.  She spent a lot of time in my house with
my family from age 2 up and she spent much time in my lap, but no one can
replace mom, and that brain growth early on is so crucial.

Back to marijuana:  Aren't there indiginous populations in the world where
cannabis use is wide-spread?  What do we know about their use of the drug in
women of child-bearing age?  Have their kids been evaluated for sequalae?

Barbara Wilson-Clay, BSE, IBCLC
priv. pract . in Austin, Tx