Mid last year (June 2022), I started a blog series on cannabis and lactation. The first volume of Lit Tits was a highly read blog, pun intended.
I posted it on my Instagram and from there it was shared hundreds of times, making its way to Twitter and liked by the NY Cannabis Times, shout out to them, a repost would be cooler tho! The first installment of my series has over 1,300+ organic views and counting. Go share it, let's keep spreading the cannapositive vibes. Also follow my TikTok for more fun info!
Now, this tells us a few things:
1. Humans are naturally and inherently curious
2. We are life long learners
3. Most want to be educated on their options for health and wellness
I posted a video on my TikTok about alcohol and lactation, that video blew up in a few hours with over 400k+ views and counting. The most common theme amongst the comments besides "should I pump and dump?" was "What about the 🍃?". I kindly directed them with a TikTok response video to my original Lit Tits blog and hoped they would get the answers they needed. However, some innanet troll made this silly comment "Black people loveee to gatekeep" I won't call you out, but thank you for inspiring me to write this third installment of my blog series. No gatekeeping here, the facts are very visible. I love to share current information that might be helpful to parents.
(TLDR) Answer key for those wanting to get straight to the point:
People often say or ask me "So...can I smoke?"
So the "smart ass" answer would be: "You can do what you want."
The quick & dirty clinical answer is: Almost no medication taken by a lactating person requires them to stop or interrupt chest/breastfeeding.
The reality answer is: Only you can answer that question with evidence based information to make an informed decision for yourself, your baby and family.
That's not 'gatekeeping', when you are giving info for people to have freedom of choice. There is no yes or no / right or wrong answer to this question. It is NEVER my job to tell a family how to live their life, I can only provide guidance with my expertise, knowledge and experience to provide recommendations and education. As Bobby Brown says it best "It's your prerogative, you can do what you wanna do."
One thing we need to do, is find ways for parents to use their voice and have a seat at the table when it comes to being more engaged in advocacy around healthy equity, decriminalization and cannabis policy. I'm talking about the legalization of cannabis federally. While, it's legalized in several states for medicinal and recreational usage. According to US News, Twenty-one states – along with Washington, D.C. and Guam – have acted to legalize recreational marijuana.
Yet, it's still not recognized legally to the feds as the amazing herbal medicine that it is. If it was federal policy to allow marijuana manufacturing and consumption nationwide, it would certainly help us to easily get more clinical research trials underway. This would help us understand proper dosage per person, and explanations for instructions for each method of use. Then our answers would be more solid!
The State of California has a good webpage explaining the different medical conditions that apply to getting a medicinal marijuana card to treat symptoms and ailments from migraine to Arthritis and Anorexia, Migraines, Seizures and everything in between. You may also find information on your county website, if you are in one of the legalized states, for example, here is the link to apply if you are in San Diego, California. Weed is very helpful for many people looking for a pills over plants--holistic option for treatment. Why is it such a problem to make it a federally accepted policy? The answer for almost every why in America, the C word, Capitali$m, yea I spelled that right. But I digress...
While we wait for that to happen, I've decided to continue using my public platforms as a way to help folks self educate on the usage of cannabis during lactation so that we can feel more comfortable making informed decisions.
Many people are afraid to ask their health care providers for this information due to stigma, shame and even threats from the corrupt child welfare system. I really wish ALL providers would do what they are supposed to do, PROVIDE, information and knowledge for their clients to make their OWN informed decision on their lifestyle habits and choice of treatment. I use motivational interviewing to help my clients open up about their lifestyle choices. I don't do it with a judg-y face, I'm aware of my expression and tone which is how and why they are OK opening up to me.
We also must ask ourselves, What is safer for the baby?--Breastfeeding with insignificant amounts of drug in the milk or the use of artificial milk due to choosing to smoke instead of breastfeed?” The answer from most good lactation consultants will be in most scenarios “continue with breastfeeding the benefits of the milk itself far outweigh the risks of minuscule amounts of substances in it. It is more beneficial to the lactating person and the baby to keep milk production going".
In 2006, Denise Fisher, IBCLC, RN, concluded that "little current evidence of long-term detrimental effects to the baby of smoking weed while breastfeeding, there is well established evidence that artificial milks can have detrimental long term effects."
This doesn't meant I'm anti-formula, and this is written in no way to shame those who choose to formula feed.
Now, let's talk about answers...
Marijuana, also known as cannabis or weed—and many other whimsical names—comprises the shredded leaves, flowers, stems and seeds of the hemp plant Cannabis sativa. Cannabis has been used as a medicinal healing plant throughout the world for thousands of years.
Tetrahydrocannabinol (THC) is the compound in marijuana. THC is very highly protein bound, to be specific 99.9% protein bound. When taken by mouth, it is very poorly absorbed from the intestinal tract with only 6 - 20% of it being absorbed. Since it is high protein binding, it is unlikely that significant amounts will get into the milk.
Cannabidiol (CBD) is acceptably used as treatment for a myriad of medical disorders. It taken orally the absorption is low, less than 20%.
Does THC or CBD go into human milk?
Marijuana contains THC and some CBD. THC is secreted into human milk in small quantities (Cannabis. LactMed. 2022) or small to moderate amounts. Very little is known about the transfer of cannabidiol (CBD) into human milk.
THC thrives on parts of the body that have a rich blood supply source. Places like the heart, lungs, liver and of course in this case, the chest/breast--which are full of fat and as we know, THC accumulates in our fat tissue. One time or occasional use likely wouldn't be a hinderance to a healthy milk supply, but sustained or prolonged use (daily use over months or years) could possibly.
How long does THC/Cannabis stay in my system?
THC has a long half life (the time required for any specified property--the concentration of a substance in the body--to decrease by half) and can accumulate in our fatty tissues. The longer the half life on a substance, means the longer it takes for the body to eliminate it. In this case, according to Hales Medications and Mothers' Milk, the half life of cannabis is 25 - 27 hours.
LactMed (2022) states that the length of time THC can be detected in milk ranges from 6 days to more than 6 weeks. THC may be detected in the body for up to a month after the last use because it is stored in body fat. A good rule of thumb is that substance concentration becomes negligible after five half lives. The amounts detected in human milk are very small compared to the adult dose (Hale, 2022; Baker et al, 2018).
When does THC start to show up in my system?
When you smoke it, it can be detected in the bloodstream within seconds of an inhale. That's why you get that "the weed hitting good" feeling almost immediately after your puff. THC is at it's highest peak of concentration within about 3 - 10 minutes of smoking it.
How does it affect the baby?
There is limited and conflicting research on how THC exposure through chest/breastfeeding may affect the baby.
The ABM (Academy of Breastfeeding Medicine) 2015 explains that it is difficult to make recommendations for lactation due to scarce research on the effects of exposure of babies to marijuana via breastfeeding alone and not via pregnancy as well.
Effects on a baby. The data on cannabis exposure infant brain development is limited. We speculate that it may affect mental and/or motor development. It can make a baby excessively sleepy (not good if they are newborn trying to get back to birth weight within first 2 weeks of life; could be harmful to milk supply by decreasing production if not pumping in place of baby's feed if it causes them to sleep through feeding time) (ABM, 2015: Halesmeds.com, 2022). It's best to be aware of your baby's general health conditions, needs and age/stage of life when making decisions around cannabis use and chest/breastfeeding.
SIDS. Smoking anything around a baby has a number of health risks. It is a known risk factor for Sudden Infant Death Syndrome (SIDS) (LactMed, 2022). Nicotine/Tobacco, Cannabis, or anything else smokeable shouldn’t be done in the vicinity of a baby as they will be exposed to secondhand smoke.
What does the research say?
Current existing studies on weed while breastfeeding various flaws in the study designs and very small sample sizes, which isn't helpful. Additionally, many studies were conducted in the 70's and 80's when the weed was well, not as strong. It's true when our parents say the weed hits much harder than it used to. Back when our parents smoked (60 years old and up folks) the potency was around 3% and now it's much higher, around 12% and up. Check your labels, I know I've seen some dispensaries lowest dose at 17%, yikes for the lightweights or those looking for a lower dose for everyday medicinal needs or parents choosing to consume while lactating. Check your labels y'all!
A few excerpts from studies on cannabis and lactation:
In 2018 Thomas Hale—author of Hale’s Medications and Mothers’ Milk Online and fellow researcher Teresa Baker completed a small study, of 8 women, on how marijuana affects breast milk. THC was found at low concentrations in breast milk —on average 2.5% of the mother’s dose and because the amount of THC absorbed orally is low (less than 1 - 6 %), the dose absorbed by the breastfed baby is likely to be very small.
In 1990 a paper written by Astley and Little found only slight changes in motor development of 68 infants at one year of age where mothers were smoking marijuana regularly. No effect was noted on the infants’ mental development.
Tennes et al didn’t find any significant differences in infants’ growth, mental and motor development at one year of age. The study included 756 participating women who used marijuana prenatally and postnatally, of which only 62 infants were breastfed and only 6 had daily exposure to marijuana.
In 1982 a study conducted with two women by Perez Reyes and Wall. One of the mothers reported smoking 1x / day for seven months and the other reported smoking 7x / day for eight months, both of the breastfed infants were said to have normal development.
So, folks still want answers... what does this limited, but there, research tell us?
General advice states reasons for contraindications of weed while lactating:
A parent's ability to care for their baby safely
(Disagree, I can name plenty of ways someone could unsafely take care of a baby without weed, let's leave la ganja out of it.)
It is a drug of abuse that passes to the baby via smoke and in small amounts via breast milk
(Disagree, it's an herb not a drug, let's compromise on substance in this case if we wanna be technical. Also, many of big Pharma drugs like Codeine (readily given after birth) and cigarettes, also pass through human milk in small amounts. We aren't telling people to not smoke cigarettes or use pain meds since the benefits of breastmilk outweigh the risks of smoking. We say "consider abstaining, but if not--smoke outside, wear a smoking jacket, wait until immediately after feeding to smoke."
Secondhand smoke /smoke inhalation is harmful
(Agreed, secondhand smoke is harmful to everyone. I advise parents, if they MUST smoke, don't do it around the baby/kids. Don't bring the smoke in the house through your clothes. Secondhand smoke of any kind elevates the risk for SIDS--sudden infant death syndrome).
The drug’s profile may have the potential to affect a baby’s developing brain
(Disagree, we don't have enough research or trials conducted to concretely determine that delays in infant brain development are specifically caused by cannabis consumption in a parent.)
Street drugs are often mixed with tobacco and/or potentially more dangerous substances giving a combined effect.
(Disagree, cannabis isn't a "street drug" like heroin, crack or meth, most people are going to very legitimate public dispensaries. So, were you getting it from? El Chapo, the drug cartel man himself, or your local WellGreens...parents aren't stupid. Last time I checked, I haven't had a parent who came to me asking if their crack laced weed was ok to use. Cross fades of alcohol and weed would be more common, again we just have to educate people on how this stuff works within their body, human milk and baby safety.)
A mother may also be taking other more dangerous drugs in other forms—compounding the risk to the baby.
(Disagree, the stigma is so real in this one. The reason why people open up to me as a lactation consultant is because I don't shame them when they ask me things! I have been asked some wild questions, and everything from more commonly asked about "magic mushrooms" to the more simple "energy drinks". Everyone that uses marijuana isn't doing so for recreational purposes and this means, it's not always a "do you like to party?" type of thing. Many parents nowadays are using cannabis to treat postpartum mood and anxiety disorders, eating disorders and chronic pain--parents are waiting to have children later (older) and our oldness comes with aches and discomforts from bodily changes.
Expert Opinions:
Infantrisk.com was created by Dr. Thomas Hale, Ph.D. says that if a person is using marijuana, their baby’s urine can be monitored to check the levels in the baby.
If she ONLY used [marijuana], then I wouldn’t be too concerned about her breastfeeding. I’d simply tell her that it passes into milk easily, and we are going to bring her infant in at one month and do a urine screen on the infant.
"Acute one-time marijuana smoking suppresses serum concentrations of (Lh) luteinizing hormone and prolactin in nonpregnant, nonlactating women. The effects of long-term use is unclear, with some studies finding no effect on serum prolactin. However, hyperprolactinemia [a really high level of prolactin] has been reported in some chronic cannabis users, and galactorrhea [spontaneous milk production] and hyperprolactinemia were reported in a woman who smoked marijuana for over 1 year. The prolactin level in a mother with established lactation may not affect her ability to breastfeed."
Prolactin is a hormone that affects milk production. LactMed summarises the research and concludes that the effects of long term cannabis use on prolactin are not clear since some studies found lower prolactin, some found no difference and some found really high levels.
Dr. Jack Newman, a well respected Pediatrician:
"If a mother is using marijuana occasionally, and is capable of taking good care of the baby, there is no reason to advise formula. There is no evidence that the small amounts present in the milk will harm the baby."
In Conclusion:
Informed decision-making, achieves the best outcome for both baby and parent.
The facts of life are that it's 2023, people are using cannabis in various forms and we are seeing more states legalize it, so we NEED to talk about this and stop sweeping it under the rug and not give parents answers. Telling folks they just have to stop using cannabis is not the answer. Cannabis and lactation is not a black and white issue, just like with any lactation conundrum, there’s no ‘one answer fits all’ solution or blanket protocol that works for everyone. Instead we must work together to help limit/reduce use if desired and explain the benefits, risks, alternatives to use while lactating as well as the affects if may have on a parent and their infant.
When smoking weed occasionally, the many benefits of breastfeeding typically lower some of the side effects of smoking. The AAP states that human milk has numerous valuable health benefits for a lactating person and infant, particularly a preterm infant.
Human milk is the ideal first food for optimum growth, health and mental development.
Human milk is natural medicine for babies and breastfeeding isn't just about nourishment.
This should be considered along with concerns about the likelihood or degree of drug exposure the baby has if breastfed.
Lastly, breastfeeding can be an empowering and life changing experience for a new parent, the choice of occasional or infrequent cannabis use shouldn't take that opportunity away.
Key Take Aways:
Understand the risks of smoking weed on baby’s brain development and SIDS risk with secondhand smoke
Know the benefits of breastfeeding; how they outweigh risks of cannabis consumption
Be aware of how you are using it and what else might be in it--vapes sometimes have nicotine or funky unhealthy, harmful & harsh additives. Look for pure/clean THC oils and lowest dosages, avoids vapes if possible over edibles, topicals and flower
Get help to reduce, limit or stop using marijuana to reduce your baby’s exposure, especially if you are a heavy/daily user
Ask a trusted IBCLC and/or other licensed health care provider for their opinion on the safety and circumstances around the occasional use of marijuana while chest/breastfeeding for more clarifying answer for your individual situation
Until next time!
Vol 4 will talk about how the different methods of cannabis consumption effect you differently and vary greatly from smoke/inhalation of cannabis. For those who are choosing to consume and will not be abstaining, we will also go more into "the how" with regards to how to practice "safer" use of cannabis while breastfeeding.
Counseling the Nursing Mother, Lauwers and Swisher 2015, p 241
Jack Newman & Teresa Pitman, 2014 Dr. Jack Newman’s Guide to Breastfeeding
Book a consult with me here - some insurances accepted. Online/telehealth visits available!