Breastfeeding
Q: Hello Nurse Anne, I am the mother of a 3 month old baby, and I am having severe insomnia. In the past, cannabis has helped me to sleep, but I am breastfeeding my baby and I'm concerned about the effects of my cannabis use on my child. It seems impossible to find a clear answer on this. The alternative to using cannabis is to use prescription drugs, and I have a hunch that a little bit of cannabis is better than synthetic drugs, although they are legal. Do you have any information or studies that reference breastfed babies and cannabis use by the mother? Thank you! --Star
A: Dear Star,
First of all, blessings to you and the new life you have brought into the world. Sleep is an issue for nearly all new mothers. Caring for a new baby is exhausting and it sounds like sleep has been an issue prior to the baby as well.
I also thank you for bringing up this important topic about using cannabis as medicine while breastfeeding. Most women feel uncomfortable talking with friends and would not feel comfortable asking their doctors. It can be scary since hospitals routinely screen newborns for drugs, and testing positive can result in child abuse allegations. How scary is that!
Much of the conservative policy adopted by doctors and hospitals is based on unreliable information and fear of the unknown. Much of the research they cite has significant flaws that include:
1. Research done on animals exposed to cannabis, not necessarily accurate for humans.
2. Human studies are often based on populations that used more than one substance, commonly alcohol and tobacco along with cannabis.
3. Some study outcomes are based on results of tests on adolescents, years after the newborn period.
The limitations on research are significant, so as you say Star, there is no really clear information.
Currently few health care providers will recommend cannabis during pregnancy or breast feeding in the U.S. because without extensive reassuring data on safety and long-term effects, they fear losing their medical license.
However, we do know some clear information from laboratory work done in the last few decades. We know that the health of the baby and mother is greatly dependent on an elegant signaling system all animals and humans have called the endocannabinoid system. This system was discovered in the 60’s by the Israeli chemist, Rafael Mechoulam. (http://cannabisclinicians.org/dr-mechoulam/) 90% of healthcare providers have no education on this very important system, so you will not find too many doctors able to discuss it with you.
The endocannabinoid system contains receptors which are plentiful throughout the body in our vital organs, including the brain. We produce our own cannabinoids internally that trigger these endocannabinoid receptors. At least two of the estimated 80 cannabinoids in cannabis (THC and CBD) also trigger these receptors. All cannabinoids act as adaptogens and are responsible for keeping our body systems in balance.
The endocannabinoid system is essential to survival. For example, in Israel, a noted scientist (Dr. Ester Fride) found that newborn rats who had their cannabinoid receptors blocked had no suckling behavior and died due to failure to thrive. If those same rats were treated with THC in the first 24 hours, they survived. So you see, this system is a natural part of the human physiology.
Many worry about transfer of cannabinoids through breastmilk to infants who are breastfeeding. An OB/GYN survey done by two researchers at the University of Arizona (Meg Hill MBBS and Kathryn Reed M.D.) reported: “Analysis of breast milk reveals the presence of marijuana in recent users, where is it bound by proteins. However seeing that breast milk contains less than 1% of protein, the transfer of this drug is likely equal to this protein level”. One study calculated exposure at 0.8% of maternal intake. Not as significant as some would like to believe, and this is somewhat reassuring.
Dr. Stacey Kerr, the medical director of our local Sonoma County Breastfeeding Coalition, communicated with a lactation specialist on the subject. Anne Eglash M.D, the Director of University of Washington Health Lactation Services, said, “I realize that marijuana is a tough one, and it certainly is not ideal for a breastfeeding mothers to be smoking cannabis. However the protocol is to encourage mothers to continue breastfeeding while minimizing infant exposure to smoke and reducing marijuana use.” This is a soft note of caution.
The best, most comprehensive study to date that examines the use of marijuana during and after pregnancy was done by Melanie Dreher R.N PHD in the 1990’s. She studied Jamaican women who use marijuana medicinally in a cultural context. Her findings were published in the journal Pediatrics in 1994.
Most women drank marijuana in a tea known as ganja tea and a smaller number smoked it. Following birth, 24 babies who mothers used marijuana and 20 babies of women who abstained were followed. Neonatal outcomes in the first week were equivalent. After 30 days no detrimental effects of marijuana use were reported. The women who were habitual users rated their experience of motherhood more favorably than those abstaining. At 30 days the exposed babies did better on all scales, especially two of the scales having to do with autonomic stability and reflexes.
Dr. Dreher did not stop there. Follow-up studies were done at 4 and 5 years old, just before entering school and just after. The kids were measured in verbal skills, perceptivity, quantitative skills, memory and motor skills. A 72 item questionnaire was filled out by the child’s primary care giver. No differences were noted, even taking into account socioeconomic status. Performance on the exposed children in areas of school performance and social skills were above the children of those women who abstained. Of note is that children in this culture are given ganja tea medicinally throughout their lives. Dr. Dreher’s well designed study is certainly reassuring.
All of this information is available on the internet, along with much information that is not reliable. You will need to be careful as you evaluate the worth of information you find on a Google search!
Star, I wish you continued success with breastfeeding. In your own estimation, the benefits of using cannabis as medicine should outweigh the possible risks, and you are the only one who can make that judgement. I encourage you to call upon all of your resources to help with getting as much rest as you can.
Warm regards,
Nurse Anne
