I am hesitant at commenting, as there may be a culture gap here,  and 
practice in the US may be expressed in different wording from what I 
am used to, but I am very, very uncomfortable about *any* mother 
being 'instructed by the physician'  - instructed!! - not to 
breastfeed, under any circumstances whatsoever.  I don't like the 
term 'allow' when used in this context, either. Moreover, to have 
this approach extended to cannbis use seems heavy-handed.


Apart from the principle of the thing, there may be a lack of 
evidence that this is the right approach clinically.

A mother who has used drugs in pregnancy may find her baby is born 
addicted. It is cruel in the extreme for her baby to be prevented 
from having breastmilk, as giving an addicted baby breastmilk helps 
avoid painful and distressing withdrawal symptoms.

The Glasgow unit that specialises in treating drug-using mothers and 
babies actively encourages mothers to breastfeed or at least to 
express, and apparently a majority of them do. The baby can then be 
weaned off breastmilk gradually and the onto formula if the mother 
decides not to continue breastfeeding, or if she is unable to stop 
her drug use (and yes, if she continued using drugs and continued to 
breastfeed, social workers would indeed be informed of this).

But should we ever enshrine in a protocol the notions of 'allowing' 
and 'instructing'?

Heather Welford Neil
NCT bfc, tutor, UK

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