This is a risk-benefit decision made by our physicians!

Speaking from experience, I think it is naive for healthcare workers to think that because we tell a mom to stop smoking marijuana during pregnancy or breastfeeding that they are going to follow our advice!  This is obvious to all of us working in a hospital because we see moms all the time who have had prenatal care and who have been counseled by their OB to stop smoking and have chosen to ignore that advice!  In fact, routinely our mothers continue to deny smoking and the typical story is that they went to a party where others were smoking!  If their choice was to breastfeed their infant all along and we tell them they should not be smoking marijuana while breastfeeding, I would be pessimistic that their behavior will change once baby is born- and I'm an optimist!

In our hospital, we urine drug test (UDS) mothers on admission who tested positive during any of their prenatal visits or if they had late/limited PNC.  If mother tests positive for any illegal substance (no prescription), we are required to let DSS know of the test results. A "safety plan" is put in place which is a "protector" (usually a family member) who has tested negative for drugs.  Officially, that baby is not allowed to be with parents without the protector present (right!).  DSS is overworked and understaffed.  THC is the least of their worries so who knows what f/u care and monitoring is actually carried out.  I KNOW these moms continue to breastfeed or pump for baby because they share it with me! 

If there is no other history of substance use/abuse and she has had consistent prenatal care, our physicians and staff counsel/educate on the risks of continued use to infant and family and the recommendation to stop.  After leaving our care, we can only hope that they think about the risks and at least consider decreasing the amount they smoke and where they smoke!  Having an open case with DSS brings a whole new aspect to one's life and more motivation to stop the illegal (in SC) use! 

Bottom line?  After educating, our moms are allowed to breastfeed so those little ones can benefit from the liquid gold we all love!  

Holly Prescott RN BSN IBCLC
Southeast

A few more resource highlights:

ABM clinical protocol #21
Exposure to second-hand marijuana smoke by infants has been associated with an independent two times possible risk of sudden infant death syndrome (SIDS)46 (III); because breastfeeding reduces risk of SIDS, this needs to be additionally considered. Thus careful contemplation of these issues should be fully incorporated into the care plans of the lactating woman in the setting of THC use. Breastfeeding mothers should be counseled to reduce or eliminate their use of marijuana to avoid exposing their infants to this substance and advised of the possible long-term neurobehavioral effects from continued use. 

LACTMED 2019
In general, professional guidelines recommend that cannabis use should be avoided by nursing mothers, and nursing mothers should be informed of possible adverse effects on infant development from exposure to cannabis compounds in breastmilk. In addition to possible adverse effects from cannabinoids in breastmilk, paternal cannabis use may also increase the risk of sudden infant death syndrome in breastfed infants. Cannabis should not be smoked by anyone in the vicinity of infants because the infants may be exposed by inhaling the smoke.

CDC 2018
However, data on the effects of marijuana exposure to the infant through breastfeeding are limited and conflicting. To limit potential risk to the infant, breastfeeding mothers who use marijuana should be encouraged to abstain from or significantly reduce marijuana use.

Breastfeeding Med 2018
The challenge is whether women who do choose to continue use of marijuana use should be advised to stop breastfeeding. This is a risk-benefit decision.  Health care providers counseling breastfeeding mothers should have an informed discussion weighing carefully the risks of cannabinoid exposure and potential impact on neurodevelopment against the benefits of breastfeeding. Current data suggest that the safest choice is no use of marijuana while breastfeeding.

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