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From:
Arly Helm <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 5 Dec 2004 09:16:37 -0800
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A Lactnetter brings up the concern that providing information about
marijuana, especially in those situations where the mother has already used
some, may conflict with local, state, or federal laws.  Another Lactnetter
brings up the fact that the laws with regard to marijuana differ from place
to place and over time, and also with respect to the severity with which
they are pursued.

In my opinion our first obligation is to the health of the baby, secondly
the mother, and thirdly the family.  In US history, there have indeed been
laws which made it illegal to offer accurate health information to women.
The infamous "Comstock laws," for example, prohibited publication and
distribution of information about sex, sexuality, contraception, and human
reproduction.  Those who provided this information--now found in biology
textbooks--committed acts of civil disobedience.

No matter what the current legal status is for USE of marijuana, the status
for giving accurate INFORMATION (what little of it we may have) to
breastfeeding mothers should remain free of legal hindrance. If it is not,
we have to consider--individually--whether an act of civil disobedience
meets a higher ethical standard.

As for reporting breastfeeding mothers to Children's Protective Services for
any use of marijuana, this is clearly--to me--in violation of both common
sense and ethics, if we are to put the baby's needs first.  We would not
report mothers for illegal use of cable TV, because this illegal action
would not constitute a greater harm than having the baby possibly removed
from the family.  We are not charged with enforcing local, state or federal
laws, but rather with advocating for the health of our clients.  It is not
whether an action is defined as illegal in that time or place which is of
concern, but how any action, legal or not, affects the baby's welfare, and
the health of the mother and family.  If our information indicates that a
small amount of marijuana or any other substance is less harmful than
formula, what would reporting the mother to CPS achieve which a talk about
the potential risks of the substance not do better and at less risk to the
baby?

In the following illegal case scenario in the US, which of us would report
the mother to CPS for possible removal of the baby:

A 20-year-old white woman, married since age 18 to a Fed-Ex driver, is
successfully and happily breastfeeding her first child.  At 9 pm on a Sunday
night, after the baby is down for his first long nap of the night, she has a
small glass of white wine with her husband while they watch Masterpiece
Theatre on PBS.

We correctly interpret this situation as benign because of the cues we
receive and because of our own unchallenged biases.  In the US, consumption
of alcohol by those under 21 is illegal and therefore substance abuse, but
because the woman is white, has been married for some time, exhibits
stability in her life (first baby after 2 years of marriage, husband has an
excellent blue-collar job), and is watching an intellectual TV series, we
are not concerned.  This is a jumble of prejudices (her skin color, choice
of beverage and TV show are red herrings and unimportant) and important
observations (breastfeeding is successful, mom is happy, no apparent
economic or marital stress).  

Most important though, to the lactation consultant, is the fact that we know
that her body will process this small amount of alcohol long before the baby
is expected to wake for his next feeding; and to undertake this very small
risk once a week is acceptable, if it keeps this mother breastfeeding
longer.  She could have the equivalent amount of alcohol in the form of hard
liquor or beer, be from another race or ethnicity, or be watching MTV, and
the facts about the alcohol would still be true.

I would advocate for being guided by common sense and science (as it
develops) rather than a strict and perhaps misguided interpretation of the
law (as it develops).

Arly Helm, MS, IBCLC

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