I am truly not being flippant when I suggest: You already have your answer,
when you write, "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."

I say it all the time: "As IBCLCs we provide evidence-based information and
support, so the parent can make a fully-informed decision about their own
and their child's healthcare, in consultation with the primary healthcare
provider (HCP)."

So if the evidence-combers at ABM have concluded that "at this time,
although the data are not strong enough to recommend not breastfeeding with
any marijuana use, we urge caution," then this has to form the basis of the
discussion you have with a mother who uses marijuana. She deserves to know
why it is so much more risky for her baby than for her, and she deserves
support to understand why she can't use the milk she pumps and
(ouchouchouch I hate to say this) dumps (to preserve her supply) until the
THC has cleared her system.

Working in a hospital, especially with a NICU, many of us know that we will
have to follow whatever the facility's protocol is.  And many facilities
will have strict policies ("Test positive? No breastmilk! Period!") that
paternalistically disempower the family. It is what it is.

I find that an awful lot of maternal-child health is *very* judgmental
about just how "good" we think mothers and families can be.  Think about
how HCPs react when they hear a mother had no pre-natal care, or is a
tennager, or use(s)(d) booze-drugs-pot-pills, or is in an abusive
relationship ("Why doesn't she just leave?"  Why, indeed.), or smokes
cigarettes, or has horrid teeth.

The flip side is to ask: How in the heck does handing a mother a six pack
of formula, kicking her out the door, and telling her "Egads do not ever BF
your baby!" do one stinkin' thing to help the baby?

The bottom line on ANY risky behaviors by ANY patient/client is to offer
.... evidence-based information and support, so the parent can make a
fully-informed decision about their own and their child's healthcare, in
consultation with the primary HCP. Some facilities will allow us to do it.
Others will shut us down with paternalistic policies, but until those
policies are changed, they are a condition of employement.

There is a stupendous program out of VT to help opioid-dependent families
through pregnancy, childbirth, YES support for breastfeeding, and follow-up
support.  I know marijuana is not an opiod, BUT my point is that with
intensive, cross-disciplinary support (and yes, it is intensive) families
CAN be given the information and help they need to reduce health risks and
improve long-term outcomes for everyone in the family.
https://www.uvm.edu/medicine/vchip/documents/ICONFULLTREATMENTGUIDELINESFINAL.pdf


-- 
Liz Brooks, JD, IBCLC, FILCA
Wyndmoor, PA, USA
Chair, ILCA Nominations Cmte (2014-16)
Secretary, U. S. Breastfeeding Cmte (2014-16)
Director, Human Milk Banking Assn of North America (2015-18)
"IBCLCs empower women and save babies' lives!"-Ursuline Singleton

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