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.
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St.Peter Hospital Family Practice Residency
525 Lilly Road NE
Olympia, WA  98506
360/493-4040