Improving Practice Standards Surrounding Birth, Breastfeeding, Cannabis, and Beyond

shutterstock_461418109Cannabis use during pregnancy is a significantly challenging topic. In addition to the challenges pregnant women face should they choose to use cannabis to treat pregnancy-induced nausea and vomiting, there are serious problems and consequences surrounding breastfeeding. As an RN (also a non-practicing doula and prenatal yoga teacher) who specializes in women’s health and advocates for uninterrupted birth — I find these issues to be most concerning.

Women who test positive for THC throughout their pregnancies, and following labor and delivery, are advised against breastfeeding. Using the term “advised” is a kind understatement — these women are usually forced to give up breastfeeding from the start. The hours following birth are very sensitive and interfering with a mother’s ability to breastfeed places both mother and baby at risk for significant trauma — especially if the mother plans on breastfeeding. Preventing a new mother who planned to breastfeed from doing so will almost certainly send her into a significant experience of postpartum depression (PPD) which may impede her ability to bond with her baby. In the case of the infant, that baby may not learn to latch properly, that baby may not receive any of the dense nutrients from colostrum, and stimulating lactation may be impeded. The consequences could be devastating long term as we know that breastfeeding is important for the development of the healthy human microbiome — the well-functioning immune system. Therefore, my concern is that interfering with a mother’s ability to breastfeed from the start could potentially set baby up for a lifetime of risk related to inadequate immune function, in addition to the risks associated with creating trauma for a brand new family.

Recently, Dr. Thomas Hale, PhD — the author of Medications and Mother’s Milk — one of the foremost authorities surrounding pharmacology and the perinatal periodcommenced a study to determine the pharmacokinetics of delta-9-tetrahydrocannabinol (THC) in breastmilk. Participants were asked to collect breastmilk for 6 hours after smoking a determined amount of cannabis flower. What he and his colleague, Dr. Teresa Baker, found was that cannabis is not concentrated in breastmilk. This alone is reason enough to review and amend practice standards, but let’s look at this on a broader scale. Read more about Dr. Hale’s study here —

In medicine, when it comes to breastfeeding — the rationale for breastfeeding with substances on board comes down to weighing the benefits versus risks. Women who take some SSRIs, opioid/narcotic medications, and benzodiazepenes (sometimes a combination of all three) are encouraged to breastfeed despite the known risks associated with exposing neonates and infants to these medications via breastmilk. All risks with these substances are considered low by the medical establishment. Women who smoke tobacco are encouraged to use nicotine patches (or Wellbutrin — another SSRI) and breastfeed despite data that suggests nicotine exposure is a major factor in the occurrence of SIDS. To this end, we have limited understanding of the the long term risks associated with exposure to these medications for these babies. The research does indicate that the impacts from these substances may include neurobehavioral and potential cognitive challenges in exposed infants. The research also suggests that the impacts for babies exposed to cannabis long-term may include similar challenges.

So if all things are equal (not even close, but hopefully someday soon), and the research indicates that similar risks are associated with exposure to the aforementioned prescription medications as well as cannabis, then we need to stop interfering with women who choose to medicate with cannabis to treat their symptoms. Legalized states especially should no longer maintain such standards. Women who make such decisions should be able to discuss their cannabis use with their doctors, midwives, nurses, and pediatricians for the best outcomes across the board. Families face enough challenges, trauma caused by the medical establishment and Child Protective Services following birth of a baby shouldn’t be included in those challenges. The medical establishment is doing harm by interfering with this significantly sensitive time, which is a serious violation of the Hippocratic oath — the principle which dictates that medical professionals do not cause injury or harm to their patients. It’s time to review these practice standards, to help and empower families who choose to use cannabis in a therapeutic way instead of punishing them, thereby setting them up for serious challenges as they start their new life together. The goal is healthy families, right? The answer is yes, yes it is.

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Arnold, S. (n.d.). The Shocking State of Cannabis-Related Child Protection in Massachusetts. Retrieved from

Breastfeeding and Prescription Pain Medication. (n.d.). Retrieved from

Day, N. L., Leech, S. L., & Goldschmidt, L. (2011). The Effects of Prenatal Marijuana Exposure on Delinquent Behaviors are Mediated by Measures of Neurocognitive Functioning. Retrieved from

Garry, A., Rigourd, V., Amirouche, A., Fauroux, V., Aubry, S., & Serreau, R. (2009). Cannabis and Breastfeeding. Retrieved from

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Is it safe for a smoker to breastfeed her baby? What about using the nicotine patch and other smoking cessation aids? (2008, November 12). Retrieved from

Nonacs, R., MD, PhD. (2015, August 12). Breastfeeding and Benzodiazepines: Good News. Retrieved from

Odent, M. (2002). The First Hour Following Birth: Don’t Wake the Mother!by Michel Odent. Retrieved from

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