Hi All,
Since Brenda posted that the ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, was revised, I've spent more time than I wanted to in reviewing the recommendations at our institution for Breastfeeding and Marijuana use. At our institution we've been working on a protocol that would provide guidance for the physicians and nursing staff since last May (I had posted to Lactnetters for thoughts). What I discovered then and now is that we have professionals on either side of the fence.

Anne Eglash, writes "It is important to understand that Hale's recommendations are his own, and are not consensus among a group of experts. The ABM protocol and Lactmed are not one person's opinion, they are both expert consensus opinion." According to the 2014 ed.  of Medications and Mother's Milk, pg 175, Hale writes "For single or infrequent exposures, breastfeeding can continue after 24-48 hours. For daily continued use, mothers should be advised not to breastfeed." I'd say that is a clear cut recommendation.

Nikki Lee writes in reference to the Colorado fact sheet, "The implication in many such fact sheets is that if a person is smoking marijuana, they must have a drug dependency problem." Really? That's the last thing that popped into my mind. I do thank you Nikki for referencing this fact sheet, I was not aware of it and it does have great talking points for the physician.
 
Liz Brooks writes "There is a stupendous program out of VT to help opioid-dependent families through pregnancy, childbirth, YES support for breastfeeding, and follow-up support.  I know marijuana is not an opiod, BUT my point is that with intensive, cross-disciplinary support (and yes, it is intensive) families CAN be given the information and help they need to reduce health risks and improve long-term outcomes for everyone in the family. https://www.uvm.edu/medicine/vchip/documents/ICONFULLTREATMENTGUIDELINESFINAL.pdf" but it doesn't help the mother using Marijuana.

We have used this program to develop our Breastmilk Feeding Initiation Guidelines for History of Maternal Substance Abuse, Yes, Maybe, No guidelines but it does not specifically address the use of Marijuana and quite frankly, while the new guidelines actually address Marijuana use, it still doesn't give a definitive answer. Mother's using marijuana are not in a treatment program which the guidelines reference.

When I graduated from college, one of my first conferences, probably '72 or '73 was on Fetal Alcohol Syndrome. The recommendation was and still is, no alcohol during pregnancy because we don't know what the threshold is before damage is done. While there are no concrete studies on the use of Marijuana during pregnancy and breastfeeding as with Fetal Alcohol Syndrome, there is consistent reference to neurobehavioral problems. Do we really want to wait for these consequences to present full force before we step in? It's a little late then. Are we advocating for the baby or the mother? If as an LC I tell a mother the potential problems with using Marijuana and breastfeeding and then help her breastfeed, teach her to pump and dump if necessary but don't have any way to follow up on her, that's a problem. We have no problem telling a mother she can't breastfeed because of a prescription drug she is using that has some of the same infant monitoring recommendations that Marijuana does. Why is that?

I've been an IBCLC since 1987, I used to ache for the babies that weren't breastfed. I had to let that go, it was too painful. And while I'd prefer to see every baby be breastfed, quite honestly, I'd rather err on the side of caution and say "no" to breastfeeding if marijuana is used. 

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