I realize that the marijuana issue is a tough one, and it is certainly not ideal for a breastfeeding mother to be smoking marijuana. However, I believe that the ABM protocol is consistent with Lactmed. Here is a quote from Lactmed:

'it appears preferable to encourage mothers who use marijuana to continue breastfeeding while minimizing infant exposure to marijuana smoke and reducing marijuana use.[5]'

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.

Anne



Anne Eglash MD, IBCLC, FABM
Clinical Professor, Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
Medical Director of UW Health Lactation Services
Co- Medical Director, Mothers Milk Bank of the Western Great Lakes
President of The Milk Mob,  A Gang of Breastfeeding and Human Lactation Educators
www.themilkmob.org
Breastfeeding is Nature’s Health Plan



-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of LACTNET automatic digest system
Sent: Thursday, April 16, 2015 11:00 PM
To: [log in to unmask]
Subject: LACTNET Digest - 15 Apr 2015 to 16 Apr 2015 (#2015-150)

Date:    Thu, 16 Apr 2015 11:17:24 -0400
From:    Brenda Phipps <[log in to unmask]>
Subject: New ABM Protocol on Guidelines for Breastfeeding and Substance Abuse

Hi,

I just read the newly minted Academy of Breastfeeding Medicine protofcol #21 - Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015. After reading through this, I have questions to others on this list who may have strict local hospital policies on this issue, like mine does.

The ABM protocol addresses alcohol use, opiate use, nictoine and cannabis. My question is on the cannabis recommendations. While Hale lists cannabis as an L5, and LACTMED also lists its use as contraindicated, the ABM specifically states that "Information regarding long-term effects of marijuana use by the breastfeeding mother on the infant remains insufficient to recommend complete abstention from breastfeeding initiation or continuation based on the scientific evidence at this time". It also states, "at this time, althought he data are not strong enough to recommend not breastfeeding with any marijuana use, we urge caution". 

Our hospital policy has recently been reviewed and reenforced - mothers who test positive for any illegal drugs, including marijuana (because it is an L5) in the last trimester, or who admit to its use in the last weeks of pregancy, are not to be supported with breastfeeding. This is especially true in the NICU, where babies are monitored over several days if not weeks and staff have more control over the decision to take breastmilk away from the baby. We use donor breastmilk if the infant is under 33 weeks. 

Am I the only one who finds the informatin out there very conflicting? I'm not sure how to proceed now with this new ABM protocol information, which stresses counseling the mother to not use marijuana rather than discourage her from nursing her baby. Anyone else like to chime in? 

Thank you!
Brenda Phipps, BS, IBCLC

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