> In the past few weeks during my orientation period, I've worked with a > couple moms that were "suspected" of marijuana use during pregnancy. > Therefore, I was ordered very specifically (per our LC) to refuse these moms > to breastfeed (which they very much wanted to do) until their drug screen > and their infant's urine tested negative (could take anywhere from 12-36 > hours-- collection isn't easy!). re: the > legal implications (violation of civil rights, I would guess-- I'd sue in a > heartbeat!) and the implications for bonding/milk supply/nipple > confusion/morale/etc.. > Any replies greatly appreciated (and your staff protocols, too! I'd love to > hear how others are handling this situation..): > In our hospital, we don't get too excited about marijuana use. Child Protective Services doesn't get involved with this drug, and we don't interfere with breastfeeding. With marijuana, urine screens can be positive weeks after the active properties of the drug have left the system. When we have a mom with a history of cocaine use, a toxicology screen is ordered on the Mom and the baby's urine. We explain to the mom that it can be life-threatening to the baby to breastfeed if she has used cocaine within the last 36 hours (per JHL article and University of Rochester's Lactation Study Center). Then we leave the baby in the room with the mom and with abm bottles in the crib. She does not have to admit to the drug use to us, but has the option of what to feed her baby. Because we do not have the tox result back yet, we do not have any legal right to limit her breastfeeding. We trust her judgment and caring as a mother to do what is right for her child. Most of those who have used, will choose to bottlefeed the abm. We have had a few who BF even after drug use. When the tox screen comes back positive, then we can limit their BF until 36 hours after hospital admission. We assume that she has been clean since then, although we have suspected some of using drugs supplied by visitors while inpatients. We very carefully chart the information given to the mom and her response. That is how we cover our liability. It is very important to discuss the consequences of drug use and BF with all these moms, because once they are discharged, they will do whatever they want. You cannot prevent their breastfeeding at home after subsequent drug use. So they have to have the facts to make an informed decision. Barb Berges BS, RN, IBCLC Rochester, NY