For those of you who were interested in what Lactnetters think about the
young mother who had a history of pot use and wanted to breastfeed:

There were 19 people, male and female, who responded, some of them several
times, either to the list or to me by email.  They were from at least five
countries on three  continents, so a variety of cultures/backgrounds was
represented.

Almost everyone thought the woman should continue to breastfeed, although
many  said she should be encourged to stop or to cut back on her use.  A few
qualified their approval by saying she should be tested regularly or should
be followed up by CPS, and there were a couple of suggestions that she
consider entering a drug rehab program.  (One poster thought this would be
counterproductive, and another said it would be useless if the girl didn't
want to go.)   One respondent thought the girl was probably depressed and
would benefit greatly from some nurturing and social support.   Most people
emphasized the value of breastfeeding for promoting bonding for this girl
even more than the physical benefits to the baby.

One poster said she would warn the mother of possible harm to the baby and
would not encourage her to breastfeed.  No one said they would simply tell
the mother she should not consider nursing her child, and nobody expressed
the opinion that this was a simple situation with a clear-cut, easy,
yes-or-no answer.

A few women said they themselves or friends and family members had smoked pot
while nursing with no noticeable effects on the children.  One poster from
another country where pot use is not illegal was appalled that there would be
even the possiblilty of removing a child from its mother's custody for pot
use alone. It was pointed out by several people that there is little
scientific evidence that pot is harmful to nurslings, but one poster did find
a couple of articles related to pot use during pregnancy.  (I ran a lit
search on Medline and Cinahl for the past five years, using every combination
of terms I could think of, and didn't find anything definitive on marijuana
use during lactation.  Actually, I didn't find much at all.)  Some posters
remarked on the hypocricy of condemning this girl for pot use, when women who
use tobacco and alcohol aren't threatened with loss of their children, even
though documented evidence of harm is much greater for these drugs.

There were concerns about possible concurrent use of other, more dangerous
drugs, as well as contamination of the pot by pesticides or by other street
drugs, and about the girl's ability to care for the baby properly if she is a
heavy user.  On the other hand, of course, people expressed concern about the
potential damage done by formula, which may be contaminated as well as
deficient.  One poster gave an anecdotal report of a client she had worked
with, whose failure-to-thrive baby didn't gain until the mother stopped her
daily pot use.

Thanks to all of you who took time to respond.  I found the discussion
enlightening, stimulating, and quite helpful in focusing my thoughts about
the situation.  It was also an interesting indication of how culture,
personal experience, educational and occupational backgrounds influence our
thoughts about ethical and moral matters.  It's apparent that all of us, no
matter what we think about this particular case, consider the contact we have
with nursing mothers to be both a privilege and a great responsibility.

The girl did go home breastfeeding, and when my colleague made our routine
three-day callback, the grandmother said the baby was feeding well at breast.
 (She also mentioned that the baby's face was "orange, like he's suntanned,"
so Yvonne advised her to call the pediatrician.  Grandma said she had told
the baby's mother the same thing, but she hadn't followed through yet....)

Judy Dunlap, RNC, BA, IBCLC