greennursevtSometimes you look back on your life and say, “how the heck did I get here doing this?” Well, I have been doing both birth work and herbalism for decades, so I guess the how and the doing go hand and hand – particularly when it comes to exploring the question of whether it’s appropriate to give babies human milk when the lactating parent uses cannabis.
I am often (if not always) asked for both my personal opinion, as well as information on the little research we have.
From a personal perspective, my answer is always the same. First off, it’s vital to understand the laws of your state and how that could affect you and your child. In some states, a positive test for THC means that children will automatically be removed from your home. Being informed is crucial.
Secondly, my hope for every parent (and every being), is that they are healthy and happy, with a balanced endocannabinoid system. Ideally nobody ever NEEDS any kind of supplementation. Unfortunately, that isn’t always the case. When looking for supplements, many people want to choose cannabis over pharmaceuticals. This is an understandable desire.
Harm reduction can be as simple as reminding someone to clean their pipe and change their clothes before nursing, or as involved as helping someone learn how to microdose.
So, my true role is providing education and information, and helping the lactating parent make the right choice based on their specific personal needs. Sometimes the right choice is abstinence, sometimes it’s harm reduction.
Harm reduction can be as simple as reminding someone to clean their pipe and change their clothes before nursing, or as involved as helping someone learn how to microdose.
From a professional perspective, I’ve been attending the annual Vermont Lactation Consultant Association (VLCA) conferences for as long as I can remember – well before I had the honor of becoming a board member for VLCA and before I became a research nurse at the University of Vermont College of Medicine.
At the 2014 conference, I participated in UVM’s five item survey of lactation professionals, which was published later as “Surveying Lactation Professionals Regarding Marijuana Use and Breastfeeding.”
In this initial survey:
- 44% reported their recommendations around breastfeeding and marijuana use depended on factors like the severity of maternal use.
- 41% reported recommending continued breastfeeding because the benefits outweigh the harms.
- 15% reported recommending that a woman should stop breastfeeding if she cannot stop using marijuana.
- Conference attendees estimated that 15% of their breastfeeding clients in the past year used marijuana.
Ultimately, the study concluded that “lactation professionals vary widely in their recommendations to breastfeeding clients who use marijuana,” and noted that it’s a common question which requires more research before any definitive conclusions could be drawn.
Also, while the study acknowledges that breastfeeding “is associated with substantial benefits for both the child and mother,” up until recently, most guidelines state that women who use illicit drugs should not breastfeed.
This recommendation has traditionally included marijuana, but with this drug’s changing legal status and the limited scientific research regarding marijuana’s effect on breastfeeding and the nursing child, it often leads to varying recommendations made by lactation professionals.
For all the data we’ve not yet uncovered, we do know that cannabinoids, such as tetrahydrocannabinol (THC) and cannabinol (CBD), like to stick to fat, which is abundant in human milk, and that those compounds can and may end up in human milk. However, without proper research, the health risks to infants largely remain undetermined, and current recommendations vary widely:
American Academy of Pediatrics states that “Cannabis can be detected in human milk, and…use by human milk feeding parents is of concern, particularly with regard to the infant’s long-term neurobehavioral development and thus are contraindicated.”
American College of Obstetrics and Gynecologists tells us that there is “insufficient data to evaluate the effects of marijuana use on infants during lactation and human milk feeding, and in the absence of such data, marijuana use is discouraged.”
As of 2017, Vermont no longer considers cannabis-positive urine drug screens in infants and parents a sole reason to open up a DCF case.
The Academy of Breastfeeding Medicine acknowledges the presence of conflicting data and currently recommends lactating parents “decrease or completely stop marijuana consumption due to the potential neurobehavioral consequences of prolonged exposure to the child.” The Academy also encourages lactating parents to “be cautious if using cannabis, as there is inadequate evidence to support the discontinuation of human milk feeding.”
Dr. Hale’s 2012 Medications and Parent’s Milk, often called “the Bible of breastfeeding,” placed cannabis in the highest risk category, L5 (hazardous), stating that ‘‘using the drug in human milk feeding women clearly outweighs any possible benefit from human milk feeding.”
However, in the last few years, they’ve changed this recommendation from L5 to L4 (possibly hazardous), making cannabis use no longer “contraindicated.”
Lactmed agrees, and goes even further saying that because “breastfeeding can mitigate some of the effects of smoking and little evidence of serious infant harm has been seen, it appears preferable to encourage mothers who use cannabis to continue breastfeeding and reducing or abstaining from cannabis use while minimizing infant exposure to the smoke.”
The state of Vermont has made several major policy changes when it comes to cannabis. As of 2017, Vermont no longer considers cannabis-positive urine drug screens in infants and parents a sole reason to open up a DCF case.
In 2018, Vemont legalized recreational cannabis possession, consumption and cultivation for adult use, and in 2020 passed legislation setting up a commercial marketplace for adult use cannabis.
At the 2019 VLCA conference on opioids and cannabis pregnancy and breastfeeding – where I had the pleasure of speaking – UVM conducted a follow-up survey to that 2014 survey of lactation professionals.
The results will soon be published in an article, written by myself and some colleagues, entitled “Breast/Chestfeeding and Marijuana Use: Recommendations from the Field Post Marijuana Legalization In Vermont.” In the article, we note that it’s “possible that legalization led more providers to consult professional guidelines and other authoritative sources” – which is why encouraging more studies, more data, and updated guidelines is so crucial.
Full survey and research soon to be published. Now I know the answer to the question I started this with, and why I ended up here. I am sure glad I did! Stay tuned!
Ed Note: Jessilyn works as a research nurse at the University of Vermont, is a committee member of the Vermont Lactation Consultants Association. Her presentation at the 2019 conference was called, “You Are Not Alone: Perinatal Addiction & Neonatal Abstinence…What about Cannabis?”
Photo by Luiza Braun on Unsplash