I have a bit of a dilemma I'd appreciate some opinions about. I'm supervising a resident who is caring for a young mom, delivered 1/16. She has used MJ and methamphetamine during pregnancy. Stopped the meth several months ago. Last reported MJ use about 4 weeks ago; boyfriend obviously still using. She really wants to breastfeed, claims to have quit and that she will not allow any smoking (MJ or tobacco) in house or around baby. Mom and baby both have urine tox. screens positive for marijuana. Resident says he feels mom is very committed to breastfeeding and parenting and that she has been open with him about her use. He feels she's being straight with us now. The LC and I are, however, concerned because the baby seems fairly sleepy. Birth was somewhat traumatic (spinal anes., vacuum, etc.) so it's hard to know what's the main cause of this. I reviewed all available sources, including Dr. Hale's book. I feel that if last use was truly 4 weeks ago and she truly doesn't use anymore, the risk of not breastfeeding probably outweighs the risk of low dose exposure for a short time. I'm concerned that long-term pump and dump until all MJ clears (which could be weeks yet) would likely not be successful. I told the resident and the mom that I would not recommend breastfeeding while actively using marijuana, however. We decided on a compromise: milk and blood levels were sent today, mom will pump and dump for the 3 days it will take to get the levels back. If levels are reasonably low (what's reasonably low?) and consistent with lack of recent use, I think mom could go ahead and start breastfeeding. Any comments? -- Anne Montgomery, M.D. [log in to unmask] St.Peter Hospital Family Practice Residency 525 Lilly Road NE Olympia, WA 98506 360/493-4040