A patient who reports using small amounts of marijuana every morning of
her pregnancy (she says for nausea) has delivered a baby 7 weeks preterm
and wishes to breastfeed.  She has not used marijuana since entering the
hospital one week ago.  She promises not to use it during lactation.

The hospital's attending pediatrician directed her to pump and dump for
seven days.  I did not concur, as I felt the baby's potential exposure
was already markedly less than it had been in utero, and that the
benefits of receiving colostrum/breastmilk outweighed the risks, plus
the influence of postponing breastfeeding posed an additional risk on
the potential duration of breastfeeding.  I also felt that 7 days was
somewhat arbitrary, since the baby may receive more marijuana
by-products in mature milk (after the seven days) due to changes in
composition and volume of breastmilk and the persistence of metabolite
storage in the mother's body.

The baby is doing well, on room air.

Since the 7 days is up, the question is academic, but what would you
have advised?  Since there is no risk-free choice, which risk do you
choose?

Arly Helm, MS, IBCLC

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