Transcript:
This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.
So join us for another episode. Welcome to the Milk Minute Podcast. Okay. I am simultaneously excited and nervous for this episode. Yeah. I mean, no one really likes the feeling of potentially getting canceled. Okay. Do you know why listeners? We might potentially ruffle some feathers in this episode? I don’t know, I’m going to just go ahead and guess that we’re going to push on some hot button topics that trigger people in a number of different ways.
I feel like we’re going to just like get people across the spectrum who are mad at us today, but I’m, I’m here for it. Yeah. But before you tie us to the whipping pole, please know that we have been really thoughtful about how we put this episode together for you and tried to put it together in such a way that it was more helpful than hurtful.
And most of the research that we’ve done on other people’s podcasts and research papers and the language used to describe cannabis use while breastfeeding have been pretty shame-y. So I feel like you guys deserve an episode about breastfeeding and marijuana that doesn’t make you feel like you should run for the Hills screaming.
First, can I give a shout out? Please because my husband and I went on a date night to Pittsburgh and you know, we hadn’t done that in a year. So since his 40th birthday, we have not really gone anywhere outside of Morgantown, West Virginia, which is not good for the soul. And you know, Pittsburgh, it’s not my favorite, but it’s the closest city that is not Morgantown.
That’s like bigger than Morgantown. In fact, someone told me an absolutely hilarious joke about Pittsburgh and they’re like, have you ever wondered why Pittsburgh has an H on the end? Like all of the other burgs in Pennsylvania are just like burg, B U R G not B U R G H. Like Canonsburg, you know? And I was like, no, I never thought about that. And they said, yeah, it’s because you’re actually supposed to pronounce it. Pittsburgh. Sigh.
It’s true. They just, Pittsburgh just had a bridge collapse. Did you hear about that? Oh my gosh. Yeah. I saw that the headline was bridge collapses the day Biden visits for an infrastructure conversation. I was like, yeah, that’s. Pretty much everybody in West Virginia is like, yup. That tracks. Yeah, that, that a hundred percent tracks.
But we went to see a show and we got to see the lovely Anna Rose who opened for Dan Rodriguez. And I was very impressed and I just have to give Dan a shout out because he mentioned in his show that his beautiful wife gave birth to both his boys at home and gave some love to midwives. And he was like, it was such an amazing experience.
Like we love midwives, we love home birth. And I just want to support anyone that is publicly supporting midwives and home birth and autonomy in choice. So I feel like every time somebody supports midwives, I’m like, I can forgive a lot about you to like you now. Really he was super fun and his wife has a, has a natural blog and, you know, they just seem like really cool people.
And he’s incredibly talented. It’s like if John Mayer and Johnny Depp and Jason Momoa and Chris Stapleton all had a love child, it would be Dan Rodriguez. Just imagine it. Okay. I mean, and hear it, and I’ll put a link to his Instagram in the show notes. Dan, shout out. I told you I would, I was drinking some bourbon at the time, but here’s your shout out!
I hope it lived up to the bourbon promise. Probably not. Okay. Well, I did not have that exciting of a weekend. I stayed home. Good for you. Sometimes that’s what you need to do. Well, I mean, we really had to clean the house. Isn’t that the worst? You get through the week and you’re like, I, now I have to clean up from this whole week.
Yeah. But that’s every weekend, literally every Sunday I’m like, oh look. Still the worst. A perilously tall pile of laundry. It must be Sunday. Yeah. It never gets better. So yeah. Yeah. Well, I didn’t totally finish my laundry last night, which is, so I, I was doing it cause I was like, I have to go somewhere tomorrow.
I have to leave the house and I put it in the dryer, but it didn’t dry all the way. And so I went to get clothes this morning and they were all wet. So the last pair of pants I had clean with holes in them. Now you smell weird and had a clean shirt and now I have milk stains, sweat stains, and well, the water didn’t, there’s a little water stain where I spilled. Yep. So we’re looking fan fucking tastic. And you can see all of Maureen’s stains on our Patreon if you have become a Patron, that’s one of the perks. I don’t know. I don’t, I don’t know if that’s really gonna sell it. For the low, low price of $1 a month, you too can see Maureen’s pit stains.
Anyway. Maybe we should just get onto the episode? All right. Well, before we do that, let’s answer a question. Yes. I love our question. Today’s question is from one of our wonderful patrons, Kate Hahner. Kate says, if exclusively pumping, how does my body know what my baby needs from my milk, i.e. antibodies, composition of fat, carbs, et cetera.
Thanks. This is a great question. A lot of people have this question and I think it is partially fueled from some mixed-up breastfeeding myths and facts. Right? Help us untangle it, Maureen. So a lot of people worry about this because there’s some like partial truths going around about how like your body analyzes what your baby needs through saliva and like maybe partially true, but not exactly the way that, that sounds.
There’s some exchange where yes, your areolas do some absorbing in your body’s like, Ooh, we’ve now come into contact with some interesting pathogens. What do we do? But here’s the thing. Your baby’s also like licking your face. Yeah. And sneezing in your eyeballs and you’re like changing their diaper.
And so you’re literally just constantly in contact with your baby’s body and all of their microbiome and all of the pathogens that are on their body. So unless you don’t actually have physical contact with your baby, you don’t have to worry about that because any pathogens that your body comes in contact with, it’s going to do something about them.
You know when you’re a super creep and you like, get your nose down in there and your baby’s neck cheese, and you blow around a raspberry, then you like low key lick them because we’re all just animals and we can’t help ourselves. Yeah. You’re exchanging some microbiome information there. Yeah. And, and so you’re going to be making the appropriate antibodies as much as your body is able to help them out.
As far as milk composition, what we really see is that’s just essentially about time and how often your baby nurses. So if you’re adjusting your pumping schedule to be more like how often your baby eats, that’s going to help your body put the I guess like most closely appropriate components in there.
And here’s the thing too, that changes for every baby. I mean, your milk components change all the time and they’re never going to be like not appropriate, you know. Even if you pump every two hours and your baby it’s every four hours or, you know, say you got donor milk from somebody with an eight-month-old and have a two-month-old, that’s fine.
It’s not that big of a deal. I will say though, that it’s also the environment. So your microbiome in your environment and your other family members that share that environment are sharing everything. So it’s environmental also. So if you are getting donor milk, this is a whole other question, but if you are getting donor milk from someone in a completely different microbiome, you might see some interesting gastrointestinal changes.
Yeah, no, okay, this is like a whole other episode topic, but there was some looking into like seeding donor milk with fresh milk and changing the microbiome. Anyway, it’s all very exciting, but this is all to say while these are sort of great theoretical questions, practically these are things that I don’t want you to worry about. Yeah. We’re not going to stress about that.
Okay. So everybody take a deep breath, drop your shoulders, let it out. Let all that stress go with it. Wiggle your hands. We’re going to have a long episode. So get ready. Hey, I thought you were going to be like everybody taken a long toke. I wish. No.
I can disclose up front I am not using any cannabis products right now because I’m pumping for the milk bank and that the information we’re talking about today is pretty much exclusively going to be talking, we’re going to be talking about like for healthy term infants and not preterm infants. Sounds good. Okay. Just want to get that off, off the bat.
So if you have a preemie, you’re like, can I smoke pot? We’re going to have really different recommendations. And I’ll say, my milk bank asks that I do not. Okay. They asked nicely. They’re extremely nice and I hope one day we can like you and I can drive up with a donation and go meet them. Yeah, it’s on the list.
Yeah.
Heather, did you know, I have an Etsy shop? Yes, I creep on there regularly. Well, listeners, if you didn’t know out there, I have an Etsy shop with my personal artwork on there. I have stickers, posters, t-shirts, but my favorite items are my surprise mugs. I have a couple of color changing mugs featuring my little illustrations of volvulus and breasts.
And boy, are they a surprise, especially when you give it to your boss that you do not like, and they pour hot coffee in it and labia’s a bound, I like to give them to like my mom or dad when they visit. Pour them a cup of tea and watch their face. And really, I think everybody needs these in their homes.
So if you would like one for yourself or anything else that I make you can visit etsy.com/shop/thewanderingwom6. That’s etsy.com/shop/thewanderingwom6, but with the six instead of a B. And of course that link will be in the show notes. Thanks.
Okay. Are you ready? Let’s do it. I’m so ready. We’ve been avoiding this one, but here it is. I’m going to start this episode off by saying that marijuana is not an absolute contraindication for breastfeeding. That means, and practically what is recommended by most organizations, is that if you are already using marijuana, you don’t necessarily have to stop breastfeeding or plan not to breastfeed.
This one has changed over the years, as things have become legalized in different states. And also as we’ve began to like use marijuana as a medicine versus just a recreational drug, right? You can’t say that if you are using marijuana, it’s an absolute contraindication because you would basically immediately be cutting out millions of babies from receiving breast milk.
And that has consequences. Yes. So people have had to make choices and put their foot in a certain camp. So we’re going to talk about those camps so much. Okay. So at this time, pretty much everybody agrees, it is most beneficial to the baby and the parent to encourage feeding human milk and I personally believe that we truly need to work on how we speak on this topic so we can foster open communication without shame or stigma so that we can guide patients toward the safest practices.
Absolutely. Because if you feel like your provider is instantly going to put in a CPS referral, if you admit that you want to use marijuana, or you have questions about whether marijuana would help with some of your symptoms of pregnancy. You know, that’s gonna put you in a situation where you can never have those open conversations out of fear.
And we just want to, maybe, I, I don’t even think we can fix that with this episode, but we can let you know that we are two providers who would like to have those conversations. And if you are a provider who’s maybe ready to take that step, here’s some good information that you can use to start those conversations with your patients.
Now we’re looking at marijuana, at cannabis, as something that has a long history, at least in the United States, but in many countries as an illicit and illegal drug, right. Something of a subculture, something that was just not accepted in our society, but now we’re looking at it as a legal recreational drug. And we are also looking at it as a pharmaceutical drug. So recreational cannabis has been legalized in Canada and in 18 states in the USA. I mean, medical use is legal in most states at this point. Yeah. I think it’s 37 that we can medically use cannabis in the United States right now. Yeah.
And so, you know, when we’re looking at this, it’s not a question any more of like, oh, is it worth a risk just to have fun? Which I think is the most condescending thing ever. And we see it all the time when we talk about alcohol and breastfeeding, but it’s really a question sometimes of considering this as a medicine and we have to then have the conversation around that.
Right. Are there, what medical condition are we treating? Are there alternate drugs that would actually work? And like then are those drugs actually safer or desired by the patient? And as you guys know, if you’ve listened to this podcast for a while, anything that involves breastfeeding is going to have some muddy waters when it comes to research because they don’t do experimental studies on pregnant and breastfeeding people.
So if they’re like, don’t use marijuana for this symptom, use this drug. Guess what? The best we have of that drug is retrospective data and correlation studies, which are still pretty weak evidence. Yeah. Which is pretty much what we’re in the process of collecting right now for marijuana. You know? And so that’s part of the reason that it’s considered a larger risk is because we don’t have a high quality of data that you know these public health organizations feel like is enough to make a statement. Yeah.
And also there’s confounding variables because there’s so many ways to ingest cannabis that it makes it really difficult to study. Oh my gosh. Yeah. So, and that’s the thing, like we ain’t smoking your grandma’s pot guys, you know. This isn’t even the same pot that frankly I smoked in high school or in college, you know. Like at this point, now it’s not just like one plant, this is so many strains of a plant, right.
This isn’t like, oh, the plant that’s native, you know, to certain parts of Asia and the middle east. No, no, this is now a highly genetically modified thing, right? Cause now we’re, breeding this plant for all kinds of different purposes. Now we can smoke it and vape it and eat it. And there’s ones with extra THC and ones with extra CBD.
And golly, it’s a, it’s a lot, it’s like a super pot. Whereas before, I mean, it’s gotten stronger, am I right? And in many cases, but then there’s also strains that people have that are not as strong, right? Because we’re using this medicinally. So sometimes dilution is more appropriate. I mean, sometimes children are using this medicinally, right?
Yeah. They do have a drug that actually does have cannabis in it that’s approved for treatment in children who have a very rare seizure disorder. Yeah. But can I just quickly read this FDA statement from April 2020? Oh, that’s pretty recent. Yeah. So pretty recently the FDA said, “Cannabis is a plant of the Cannabaceae family and contains more than 80 biologically active chemical compounds.”
Okay. 80. Eight Zero active compounds in cannabis. So, you know, also the FDA mentioned that there are reports of CBD potentially containing other contaminants, such as pesticides, heavy metals, bacteria, and fungi. And they’re currently investigating this. And I’m sure you’re shocked to hear this, but that’s actually one of my biggest concerns, right.
Is like what pesticides and fungicides and herbicides are on this product by the time it gets to you. Yeah. So basically if you’re the kind of person who’s trying to limit chemical exposure, you might want to think about that. But then again, how many chemical compounds are in Doritos? Yeah. I, I mean, it, it gets scary when you think too much about it, but I have to mention that.
Especially, because like, again, we have different regulations for things that are recreational versus things that are food versus things that are medicine and marijuana is kind of somewhere in the middle. Yeah. Marijuana is like, yes, please. Yeah. All of that. Yes. Yeah. And it’s really, it’s interesting.
And I just, I have to say, we’re going to go into like the science and the risks and all of that, but I feel like I could make an episode that is just as detailed and frankly, an episode that is terrifying about almost any medication that is approved for use during breastfeeding, because of the question mark at the end, like including ibuprofen and acetaminophen, like we could go into it and be like, well, there’s this one case study.
And in this study and in this study. But at the same time, those are things that were created just as a medicine by a pharmaceutical company. And I hate to say it, but I think that really colors the statements that we make about those drugs versus this as a medicinal drug, because this is also quote an illicit drug.
Yeah. I mean, if a drug is born legal, you know, it was incepted in an illegal way, right, it’s gonna have a much different anchor thought in your mind. Like you’re starting from a point of safety and this has been checked and this is great. And now like cannabis kind of went the other way. Right. So now it’s getting more regulated, but is it getting safer?
That’s right. And there’s so much out there like, ah, and all these studies and whatnot, Heather, like they would qualify the answers by saying like, but we know that people that smoked pot while breastfeeding probably smoked it while they were pregnant too. And they probably do other drugs. And you’re just like, ah, does that sound like bias?
I don’t know, like right. Are those things really correlated? Is this changing the safety rating? Is this just, you know, scientists looking at it and being like, well, if they use one drug, they use them all. Or maybe they have cannabis use disorder and whatever. Yeah. And although I will say, I did find an article from, and it was a Canadian article from Pediatrics and Child Health, and they made a statement that says from a harm reduction perspective, cannabis alone is a less harmful psychoactive substance than alcohol.
And I would tend to agree with that statement. And I don’t like, full disclosure, I just don’t really like the way cannabis makes me feel. I mean, I’ve smoked it before I’ve eaten it before. I don’t think I’ve vaped it before. I don’t remember. It must not have been that awesome. Cause I don’t remember it, but it’s not really, it’s not really my thing.
You know, it doesn’t, I don’t really enjoy the feeling. So I don’t have like a wide breadth of experience with it. But I have a very wide experience with alcohol. I mean, I’ve, I’ve tried all of that. And I can say like, from a harm reduction standpoint, I can see it. Yeah.
And you know, my bias here too, is that I have heavily used cannabis in the past. It’s been something I’ve very occasionally used in the last, you know, 10 years. I mean, partially because I didn’t have very much money, but also it just didn’t feel good to me anymore. So I kind of stopped using it, which is fine. You know, but then I also see it as a much more like socially acceptable thing and a much healthier thing. And it’s, this is a hard topic.
Let me put it to you this way. I know people that smoke a little bit of weed and then go to work and work completely fine all day long. Can’t do that if you’re a morning drinker. I don’t know anyone that drinks in the morning that functions extremely well for 10 years at a time at work. And that is where I’m coming from with the harm reduction perspective.
I absolutely agree. And you know, that, that’s the hard thing about making any blanket statements about this, right. But I have a feeling that in the next five to 10 years, we’re going to see recommendations going the way of things like tobacco use, where we’re going to see, you know, organizations be like, well, we recommend, you know, maybe you lessen it a little bit, but definitely breastfeed.
Yeah. And don’t do it here on the sidewalk. Right. Or alcohol use where there like occasional use is probably fine. We can’t say it’s safe, but it’s probably fine. Like, that’s really where I would assume that this is all going to go. But let’s dig into it a little bit more. What do you think? Yeah. And, you know, we need to talk about before we even get into the breastfeeding part of it, some general risks that are mentioned in just about every article about cannabis use in general.
So it does have a link with the severity and earlier onset of mental illness, especially when you’re exposed to it younger in life. Yeah. Like as children. And the majority of cannabis users are teens to young adults. So there is also a kind of like a chicken and egg scenario there, you know, are they using it because they already have mental illness or do they have more mental illness that developed earlier on because of the cannabis use?
So a question mark there for me but clearly that leads to problems in school. Vaping cannabis has been linked to serious and even fatal pulmonary lung diseases, which, you know, that sounds scary to me. Incidents of children and youth unintentionally ingesting and overdosing on cannabis edibles are increasing in frequency because they look like candy.
So can we clarify overdosing? That’s not them dying. They did not specify. I’m not sure you can. Well, I’m not sure. I don’t know the answer to that. I mean, what is an overdose? Like you can’t wake them up? I’m not sure. But then also of course, driving under the influence of cannabis is a big issue. Okay. So let me just say quick, the CDC says a fatal marijuana overdose is unlikely. Unlikely.
So, so this is not like heroin or so, so I would rather, I guess a child unintentionally overdose on an edible of cannabis, then a bottle of acetaminophen. Yeah. Which is horrifying, which I have seen before. Yeah, yeah. Yeah. So, okay. And this is like any other drug, any medication you’re going to take pretty much is going to enter your milk could be harmful for your infant in certain amounts.
And like most of them, it’s hard to get specific study. And I, I do want to say, you know, one of the reasons it’s hard to get specific study is because like, when you’re studying this, you have to make the choice. Are you just going to accept retrospective data from people who have used a variety of cannabis products and assume they’re all the same, because they’re not, are you going to try and accept people who’ve only used certain products, ingested them in certain ways? Like, or you’re going to actually set up a double-blind study and ask for volunteers and how ethical is that? You know, because like, if we’re just taking retrospective data, the potency of THC samples, you know, from could, could be anywhere from 2% to 15% in any, you know, given, given product and how much is going to be in your milk then is partially dose dependent.
And it’s partially going to be dependent on your individual metabolism. So that’s hard too, but let’s just talk a little bit about the science and why we have some concerns. So the biggest concern, and we’re going to focus mostly on THC because we know the most about it, is that THC loves fat. It’s highly lipid soluble, right?
So it likes to live in fatty tissues. So we have high concentrations in the brain, in fatty body tissues. And while breast milk is low fat, it still has fat in it. And contents of your milk that are water soluble kind of run in and out of it while they’re still in your breasts and get filtered out when it gets filtered out of your blood plasma.
But when it’s in the fatty molecules of your milk, it’s not as moveable. Yeah, it takes a lot of energy to move it in and out of that. And we also have a lot of fatty tissue in our breasts. So, you know, we’ve got a lot of adjacent THC hanging out there and just available. Yes. But I read in those studies that even in the milk where there is a high concentration, it’s still a subclinical presentation, which means that it’s in there.
Oh, it’s definitely in there. And it loves fat and it’s for sure in there, but it doesn’t usually cause any clinical issues. Exactly. So, you know, you’ll see a lot, cannabis has an affinity for milk and it accumulates at a higher ratio in milk versus plasma, but pretty much it’s always going to like, we’ve, we’ve never had a case where, you know, we’ve tested milk and we look at the infant and they are literally high.
Yeah. That’s what, yep. So that’s what we mean by subclinical. So like if it was a clinical concern, it would be like, oh, okay. So the plasma ratio is eight and we’re seeing effects. But currently the milk to plasma ratio is eight and it’s subclinical. We don’t really see much happening from it. But again, a concern is that even small to moderate doses are stored in the body tissues for several weeks.
And studies trying to test how long THC can stay in breast milk after use vary from six days to six weeks, you know? And it’s, it is part, it is like pretty dose dependent, right? The more you smoke, the more you’re going to see in your milk. So maybe that is partially what’s influencing it, but we’re just not totally sure about that.
Well, and also I, and I did not see a source for this, but this was what was taught to us at the hospital that I worked at previously, that if you smoke THC when you’re pregnant, it crosses a placenta, which we know to be true. And it stores itself in the fetus’s fat. And then when the fetus is born and loses weight quickly, like they all do because they’re not connected to the umbilical cord anymore and they have to actually eat to survive. So all infants lose weight, the THC is released in the system and it makes them sleepier so they don’t eat as well in the beginning. But then again, usually like it wears off and they wake up and they eat like, how is it clinically?
I mean, so I didn’t go too far into pregnancy for this, but what I did read was basically like, yes, THC crosses the placenta readily. There is some evidence that it might cause growth retardation, adverse neurodevelopmental effects, you know, with prenatal exposure. And it just seems more dangerous prenatally versus postpartum. And that’s also with most drugs.
And like, we’ve talked about before, we really don’t encourage drinking alcohol at all while pregnant, but it’s okay in moderation, occasionally postpartum. But then again, you know, one of our pet peeves is when they link pregnancy and lactation together in the same, in the same category, because they do not perform the same way.
I do want to talk about a little bit of dosage here. So I tried to look up what the relative dosage for an infant would be if the parent is smoking and it varied, of course. So there were some estimates that while an infant, like the dosage in milk might be close to about 8% of the adult adjusted dosage, they may only absorb about 1%. Which means, so there they’re ingesting 8.7% in the milk, but then what they absorb in the GI tract is one percent of the adult dosage, which is, which is in line with the subclinical presentation.
There were some other studies that were like maybe 1% to 5% absorption. Some of Dr. Hale’s research suggest the mean dosage absorption might be more like 2.5%. Well, that sounds still pretty low and on par with most medications. And Dr. Hale, by the way is the founder of Infant Risk. And he’s like the dude.
Yeah. And I have seen other estimates in possibly less reliable studies that were like wildly different. Right. And that always brings me back to what was the exclusion criteria for that study? Like were they just like, did you use pot and let’s test your milk? Or were they like, did you smoke and when and how much, and here’s when we’re going to do it?
So did you eat an entire cake? Did you take other drugs? Like who knows? And there was another I have to mention, there were some reports that suggested THC might affect lactation itself by inhibiting prolactin and thyroid stimulating hormone and some other hormonal regulation stuff. But we don’t have strong enough evidence to say, like, this could negatively impact your milk supply.
And then also, why were they smoking? Were they smoking to you know, or do they have underlying thyroid stuff anyway, like a lot of us postpartum do? So just more studies as usual would be wonderful. Yeah. Now let’s go into the more studies. A lot of our baseline recommendations from the past 10, 20 years were pretty much based off of two studies in the 1980s. Surprise.
They looked at the effect of marijuana use while breastfeeding, but the results are just not a good standard of evidence. Pretty much all their participants also used alcohol and other drugs and tobacco. So kind of muddies the waters. Right. However, even these studies didn’t really find that there were like growth in neurological developmental changes.
Really? So where are they getting this information that’s in every single review that marijuana and THC causes. So here’s the thing. There were a lot of studies that just over and over, were kind of looking at, did infants who were exposed to marijuana while breastfeeding have any developmental delays?
They’re all small studies. Most of them, the answer was no or maybe, but when we have studies on marijuana use in pregnancy, we have more and more convincing evidence that it does cause developmental delays, possibly not permanent ones as in like kids are a little behind and then they catch up, but we’re not really sure.
And the problem is for a lot of these studies where we have people using marijuana while breastfeeding, they also used it while pregnant. And I guess it appears it’s a challenge to find people who did not use any marijuana while pregnant but do use it while breastfeeding and want to participate in the study. I don’t know that you start using marijuana postpartum for the first time in your life.
Maybe you do? Yeah. Do you? Email me tell me. I, I just feel like, no offense here, but like in my mid-thirties, I feel like the experimental period is over for me. It would probably be medicinal use, right? Right. If I was going to take it up right now, it would be for some medicinal reason. But I mean, let me just say like the, like I’m not convinced that this is super risky, Heather, because let me, so there was this, even this one, right?
This one study that analyzed breast milk samples of quote, chronic heavy users. And I could not find the definition of that, but I’m going to guess that’s at least daily use and like it was like the conclusion was maybe that’s enough to produce some long-term neural behavioral functioning differences, maybe. But you know, here’s a study of 68 infants where there were no effects on development.
Here’s a study of 50 women who used while breastfeeding, no effects on development. Here was a one-year study that suggested that daily use might retard infant motor development, but not growth or neurological development. I mean, I’m going to say like the studies are small, the evidence is limited, but frankly it’s promising that occasional use might be okay.
And also we are going to link all of these sources in our professionally done transcript in our show notes. So you can, you can click that link and you can check all of these out here. And a lot of the articles I link too, then themselves have about 20 different sources that I’ve perused, just to make sure like the information I got from the articles was correct.
You know, because I can read a study, even the very definitive conclusion and come to a different conclusion than somebody else. So for a lot of these articles that were like quoting studies at me, I then went and found the studies and looked at them too, just to be like, are we sure? So I’m not going to link every single one cause then they’re already linked. So you can find it. But I have a lot of sources if you’re interested in reading. But it really is surprising to me though that like say the Infant Risk Center article, pretty much states all of these things that I just said. And then their conclusion is still that we should tell people never to use marijuana while breastfeeding.
I mean, that’s the safest way, right? Right. That’s the safest way to go. Because at this point there’s not enough studies to be like, smoking is fine, edibles are bad or the other way around. And so, and THC is found in so many different ways to ingest it. Now there’s, I think I get what they’re saying. I do get it too. It’s hard to feel like you can make a statement without liability right now.
Yeah. Especially because yeah it’s legal medicinally in 37 states, but yeah. A lot of those states do not have warnings about using pot while pregnant or breastfeeding. Really? Yeah, really. And some of them do it’s, you know, fun times. I will say though, here’s something else that I’m left wondering is when we talk about developmental delays, there are a lot of environmental factors that play into that. Like socioeconomic status, nutritional status and early childhood education and et cetera, et cetera, et cetera, especially if we’re talking about like neuro behavioral stuff.
And also was it double-blind? Did the person that was actually studying the neuro perspective? Okay. Yeah. So like, if you tell somebody, okay, go in there and you’re going to study these 10 kids and screen them for neurodevelopmental delays for a marijuana study, they might go in with bias, screening bias.
That’s part of the reason this is all not considered like a sufficient burden of evidence to make real statements. Can I just also, pet peeve when people are like, trust the science. Okay. Trust the science. I love science. Science is my shit, but the basis of science is that we’re never done. Yeah, we’re always, science inherently means we assume we are not quite there yet.
So we just keep doing more science until we figure it out. And this is definitely one of those situations where we are not even close to done. Right. And there are studies that are happening now, studies on the horizon. A lot of people use pot. So, you know, and a lot of people want to use it recreationally, medicinally.
And let me just say, like, I don’t want to cast any judgment or value. Your need and your desire to use it medicinally is wonderful. Your need and your desire to use it recreationally, also wonderful. Okay. Like, it’s not like, well, if you use it as medicine fine, you know, but not for fun. We need relaxation also.
Maybe this isn’t the way that you can get it while breastfeeding, but I don’t want to be like, you’re an evil person for even thinking about it. No, no, no, no, no, no. So please don’t allow anybody to cast that kind of judgment on you. Like here’s another example because I think examples are really helpful for people that maybe don’t work in the same space that we do.
So I have seen people admitted to labor and delivery who are nine weeks pregnant with hyperemesis and they literally cannot function. They can’t keep water down. They are on an IV drip of lactated ringers and trying to choke down popsicles for like weeks at a time, just trying not to die cause they can’t, they literally can’t eat anything.
And these people end up with Zofran, Phenergan. I mean, they ended up with a whole cocktail of medications every day. And Zofran and used to be what we would give to everybody. Oh, you got a little nausea, take some Zofran. Well, we did this with enough people. We started to see that we’re seeing some heart conditions pop up in these kids. And that’s how, you know, this has worked with pretty much every medication we use in pregnancy.
We’re like, what if we tried it? Maybe it’s not safe. Yeah. And you know, at the time it’s like, well, doctor, is it safe to take Zofran? Yes. Trust the science. Well, and it was also like weigh the risks of doing nothing versus the theoretical risks of using a medication we don’t know that much about. And a cocktail of medications like Zofran and Phenergan, all of that together. You could make the same argument then that somebody who can’t function in early pregnancy and needs a medication for nausea, maybe the theoretical risks of some developmental delays down the road are smaller than the actual risk of them possibly dying because they can’t keep any nutrients and fluid down.
So maybe cannabis could be used medicinally. Maybe so. Maybe so. I did want to have a quick little note though, that if you do use cannabis regularly, especially during your first trimester or actually I read prenatally, if you’re a heavy user, there’s a correlation here too okay. So you could get a syndrome called cannabis hyperemesis syndrome where you actually smoke so much that you can’t stop barfing and you can kind of know that that’s happening because if you take a shower and you feel better immediately, that’s what it is.
There’s something magical about a shower. So a lot of people will get admitted to the emergency room, barfing, barfing, barfing, barfing. They take a shower, they’re all better. The ER goes, yep. You have cannabis hyperemesis syndrome. They send you home. They say, keep showering and stop smoking so much. It’s really ridiculous.
It is so ridiculous. That’ll be $2,000. Exactly. Thank you. But yeah, it’s, it’s really like, we, you know, now we’re considering expanded medicinal use for this drug. So what do those conversations look like? Okay. So I, from here, if you’re ready, Heather, I want to talk about what do our public health organizations actually say about this?
I’m dying to know. Is this one of those situations where they’re all very annoyed that they have to make a statement, so they make some kind of weird you know, offhanded like kind of statement? Okay. Well let me just say, I have stuff from Lact Med, The American College of Obstetrics and Gynecology, The American Academy of Pediatrics, The Centers for Disease Control and the Academy of Breastfeeding Medicine.
They’re all the big dogs, you guys. The big dogs in pregnancy and breastfeeding. They all state, as we said up top in this episode that marijuana is not a categorical contraindication for breastfeeding. So never tell anybody that they absolutely can’t breastfeed if they’re smoking pot.
Okay. No more misinformation because I’ve seen so many doctors and nurses say that. Lact Med essentially recommends that if you can, you abstain from use or reduce your use of marijuana to minimize infant exposure. And honestly, that’s pretty much the recommendation across the board. It says exposure to marijuana smoke.
Yes. Yes. That’s different. So you know that I did see this in a few studies about okay, are there like a third hand smoke kind of situation where it’s secondhand smoke and third hand smoke where it’s like on your body or the infant is actually inhaling the smoke and is that similar to tobacco and the risks there? And they did see a correlation with that.
Same with vaping. So there was some question about the vaping smoke as well. So something to consider, like maybe don’t smoke around your baby because of the smoke. And I think that’s interesting that Lact Med specifically put marijuana smoke. Minimize infant exposure to marijuana smoke. ACOG basically says there’s insufficient data to evaluate the effects of marijuana use on infants during lactation and breastfeeding, which is funny they say them separately.
Anyway. Yeah, and in the absence of data use is discouraged. They’re going well, just don’t do it. Don’t do it. But also if you do, like, we’re not going to fire you. ABM says, of course they recommend abstaining from any marijuana use at this time, although the data are not strong enough to recommend not breastfeeding with any marijuana use, but they urge caution.
So that was a n ass backwards way of saying if you’re using pot, you can still breastfeed, but we don’t recommend smoking marijuana. Got it. Thanks ABM. They like to use those not, not statements, right? Not, not. This was the same with, what was the other one we did recently? Oh God. Every statement ever made.
I love ABM. Oh it was the one about the COVID vaccine. It sounds just like this. Okay, CDC, it recommends that you don’t use marijuana, but if a mother continues to use marijuana or CBD, while breastfeeding, she should be encouraged to significantly reduce intake to minimize secondhand smoke exposure. Marijuana products should not be smoked around babies or children.
Marijuana use may also impair a mother or other caregivers’ judgment and ability to care for an infant. I actually liked that statement. Yeah, me too. And I, I do wonder about that because like the couple times in my life that I’ve smoked, I’m not doing anything quickly. Like if you have to have a really quick reaction time to something, as you do with babies and toddlers, you might not have those supermom powers where like you snatch your kid’s ankle, right as they’re about to topple off of the counter and you grab them an inch off the floor. I just don’t know if I could do that if I was smoking. So I get that. I get it.
So now there was a 2012 AAP statement and I feel like there’s a more recent one and I couldn’t find it, but I don’t think it’s changed very much. So basically they say that they discourage use during breastfeeding and advise patients to reduce use as much as possible due to lack of safety data. But their big, it’s a big statement. There’s no language in it that prevents that says that we should prevent breastfeeding or delay initiation regardless of use of cannabis.
And they also mentioned that we need to have constructive, non-punitive policies and education for families. Yes. Good job AAP. Yeah, all about it. Good job. And then I want to go a little bit more into detail about that because hospitals have the most random ass practice guidelines for this. I don’t know about you, Heather, but I have, so I, especially like when I’m doing doula work, I get to just go to a bunch of different hospitals so that’s always fun.
But I’ve seen a variety of guidelines here, especially when I’ve gone like into Ohio, when that was a medicinal state and this one wasn’t. Some hospitals straight up tell parents, we will test you for THC. If you are positive, we will prevent you from breastfeeding. If you breastfeed, we will call CPS on you.
Oh, there’ll be a CPS referral anyway. Some hospitals give an arbitrary time to abstain from breastfeeding, from a positive screen, six hours, six days, six weeks. That’s not evidence-based. And also I’d like to see you try. I’d like to see you try to tell me not to breastfeed my child. Like, what are you going to do?
Like, oh, you’re just going to shame me into not doing it myself. Or are you going to physically remove my baby? They’re just going to call child protective services. They’re not going to; they are not going to physically remove your baby from you. But some hospitals, correct me if I’m wrong. I don’t want to give any wrong information here.
They’ll just call. I mean, the hospitals that care about that, as far as I understand, are just going to call child services. But at the same time, some hospitals don’t test and don’t care because it’s legal. Right. And they don’t say anything to you about it. Or maybe they’ll ask you in some questionnaire six months ago, you know. And then there are places where it’s medicinal, but not legal recreationally.
And we have some really weird regulations. Like, do you remember? We had one person in our Facebook group. I can’t remember if you were involved in this but asking about it because she had medicinal use. She was using it for a medical condition and she was required to have an open case with their child welfare agency.
And they required her to supplement with formula and wait four hours after her medicinal dose to breastfeed. What? Before feeding and they checked up on her and I like went into this deep hole about the state. I was like, hold up, let me look into this. Where do you live? What is this? And I went and read all the regulations.
It was totally legal for them to do that to her. How do you do that? And they were requiring her to pump and dump for four hours after her doses. And she was doing it. It was wild, it was wild. And so she was essentially half formula feeding and half breastfeeding. That’s abusive. Yeah. And I was just like, this is not in line, frankly, with any of the professional recommendations. Meanwhile, her partner’s sitting on the couch, smoking weed, probably, you know. I mean, who doesn’t have to feed them, but like where does it end?
Like it’s really just women targeted, which I really hate. It was pretty wild. And that, I really just bring that story up to illustrate the fact that these policies are off the wall, all over the place and not evidence-based usually. And a lot of places will say, you have to wait a couple of days to initiate breastfeeding if you have a positive screen when your baby’s born. But let me just say colostrum is very low in fat. Okay. Yeah. High carb. THC is concentrated in fat. So that in itself is such a backward recommendation. You know, probably the levels of THC in colostrum are extremely low and it’s such a small amount anyway.
Right. And frankly, here’s the thing. Hospital providers listen up. If we are going to have a successful lactation relationship between parent and baby, breastfeeding has to be initiated where there are professional healthcare providers who can give support. So that means at the place of birth, in the hospital, in the birth center, at home with the midwife.
Okay. And if we’re telling parents, they have to delay two days, three days, four days, whatever two weeks, by the time that they start breastfeeding, they’re going to have no support. No support, and maybe no supply with no support. So that is a recipe for ending lactation before it has begun with no evidence behind it.
It’s so sad. I mean, that story scares me. It really does scare me because I mean, hospital policy can be very different from your state’s policy and they can pretty much do what they want. Now, there are some interesting legislation things happening right now in our state, which I don’t want to draw too much attention to because I’d like them to pass.
But, you know, stating that hospitals have to be in line, that state hospitals have to be in line with what the state is saying. You know, it’s just, it makes no sense that a public hospital, it can be like, oh, actually these are the rules we’re going to follow. Even though the state says that legally, we can’t do that.
Right. Well, I, I want to go into the practical side of what ABM recommends and kind of talked about. What does that recommend? And then I want to move to, like, if you use cannabis and you’re breastfeeding, like what are the best practices that we can recommend? So ABM says that healthcare professionals should counsel parents who admit to occasional or rare use to perhaps avoid further use, or just further reduce while breastfeeding.
And just to talk about the possible long-term neuro behavioral effects, instruct them to avoid direct exposure of the infant to marijuana and its smoke. Can I add something to the very beginning, like the first thing you should probably do as a provider is to say something along the lines of, tell me about your marijuana use. Because if you ask an open-ended question like that, like tell me about your marijuana use.
You might find out that they’re smoking because they’re in an abusive relationship and they can’t deal with it, or some kind of coping mechanism that’s, that’s being used for another issue that you can solve for, you know. Like maybe this is something that they, maybe this is something that they are using for hyperemesis, and maybe you can talk to them about something else that they might be able to try before you just tell them not to do something or reduce the risk, find out why they’re doing it in the first place and see if you can help them with the thing they’re actually struggling with.
Yeah. And, and the next part of what they recommend, essentially just repeats that first part, except it’s, advise the mothers who have a positive urine screen of the same shit. So the first is when people admit to it and the second is when you catch them out. Yeah, I don’t love the language around it.
They also say that when we’re advising parents on the medicinal use of marijuana during lactation, we have to take into careful consideration and counsel on the potential risks of exposure of marijuana and the benefits of breastfeeding the infant, i.e. weigh the risks and benefits as we always do. The next part again, just says like, because we don’t have long-term follow-up data carefully consider the risks once again and recommend if possible that the parent abstains from marijuana use.
And then they conclude with, at this time, although the data are not strong enough to recommend not breastfeeding with marijuana use, we urge caution. So here’s the thing, frankly, we don’t have enough data to tell us all that much about it. We might find in a couple of years that the recommendations have changed and they say occasional use is okay.
We might find that it’s changed to say it’s not okay. And it falls into a funny category right now where if this were any other medication with simple medicinal use, we would just leave the choice up to the healthcare provider, but it is also a recreational drug. So you have a lot of choice here too. So I, I kind of want to just give a clear message of this.
This is your choice. And if you choose to use marijuana while you’re breastfeeding, here’s what I want you to consider. I highly recommend that you reduce or eliminate second and third hand smoke exposure to the infant. So that means don’t smoke it in the same space as them. And after you’ve smoked, change your clothes, wash your skin, just like with tobacco.
Know that using marijuana in any form no longer creates a safe co-sleeping situation. Yeah. Yes. So consider please crib sleeping or something else that’s safe. If you can, consider reducing your dosage or your recreational use. Question for someone that has not dabbled that much. Is one form of marijuana, easier to control the dosage than another?
Like, is there a vape pen where you can control the? I honestly, last time I used marijuana a lot, Heather, like we did not have all this fancy stuff. I do know that it’s very hard to control the dosage with edibles. Well, at this point, though, micro-dosing medicinally is such a thing though, that it’s like you can purchase very small doses in edible form.
Yeah. I don’t know. It’s like reducing the dosage. That’s kind of tough. I feel like we almost need a separate episode on that too. And bring somebody on that actually smokes a lot of weed who can tell us about this or uses it medicinally or yes. If that’s you guys, please email us because I’m very curious about this.
Reduce your dosage. It might be wary of when I say dosage, I’m talking about medicinal use. So when we’re using it medicinally, we do have like very specific dosages that you take. When I say reduce your use recreationally, you know, more practically that looks like maybe don’t do it as often. Maybe don’t quite eat or smoke as much when you do it.
Yeah. Cause there’s been times that like one puff and you’re out. And then other times where you hit that thing, like 10 times, and you’re like, it’s not working. Hence why this is a very hard topic to talk about safety on, you know, but that brings me to another point is that consider where you’re getting your marijuana and what quality it is, what strength it is, how safely it’s been grown, all of that. Yeah. Cause you know what I don’t want in my lungs more than anything in the whole world is? Fungus. I was, I was going to say pesticides. You know, I’m not kidding. You will never get rid of a fungal lung infection. You will never get rid of that thing.
It is impossible. I have seen some horrifying fungal lung infections. That scares the heck out of me. Okay. Sorry. It’s okay. My last point for trying to use marijuana in a safer way while breastfeeding is knowing that when you use this in certain dosages or certain amounts, your ability to care for your infant is going to be impaired.
So just like if you’re planning a night out drinking, understand that and plan for a safe caregiver for your baby. It sounds smart. Sounds like you are expecting that people that smoke marijuana also care about their children and want to be responsible parents. Yes. Now isn’t it nice to have some information coming from somebody with that point of view and that foundation?
Yes. And I hope Kelly Lemon will be proud of me. Yes. I was thinking about her while writing this episode and thinking like, what would Kelly say? What would Kelly say? I hope those are five things that Kelly would say. If you guys haven’t checked out our interview with Kelly Lemon on Subutex and Suboxone use and breastfeeding, please do so.
And we will link that in the show notes as well. Yeah. So I hope this was helpful. I know that a lot of this is confusing, but just know that if you want to talk about it more, we are absolutely happy to do that. Particularly if you want to come on our Patreon, I’m really happy to sit there for hours and message with you about it.
Yeah, for sure. It’s easier for us to help you on a more personal level on the Patreon than it is in the Facebook group. And it’s also more private. You can message us privately. Whereas the Facebook group, it’s, it’s hard sometimes for people to be open about their, their true question. There’s a lot of, it’s not me. It’s my friend. I’m happy to help your friend, but I’m more happy to help you. Exactly. Exactly. I hope this made you guys feel a little bit better in some way. If it did let us know. If it didn’t let us know. If there’s something else or a different angle that you were wondering about that you didn’t get in this episode, please ask.
This is really just our first overview. Yeah. I feel like we’re going to have to do some updates. I know that some research is going to be published in the next couple of years that might change all of these recommendations. So, and I’d really like to get Dr. Hale on the podcast and Dr. Hale, we sent you an email.
I did email him. I tried to get him on here. If anybody knows. What’s his first name? Thomas Thomas. If anybody knows Dr. Thomas Hale, personally, he is a professor at Texas Tech. And I had to creep so hard to get his email address. I was like next level sleuthing to get that. I really want to hear his story about how he picked out his own strain of marijuana for his research study and he had to fly to Colorado to do it because it’s not legal in Texas or it wasn’t at the time. I really want to know more, like, I want to understand a little bit more about the science of dosages and absorption rates. And he’s really the expert on that.
I also maybe want to talk to the person that invented the vape pen and just really figure that out because that, listen, it is, I did not realize until I went out with my husband, how many vapers we got out there! I mean, you can’t throw a rock without hitting a hipster vaping. You can’t. It’s fascinating. Not in Pittsburgh. Not, yeah. Not anywhere. Just the sheer amount of smoke that comes out with every toke.
I’m like, wow, look at that. I’m so uncool now because I’m getting old. It’s okay. We’re both feeling quite old today. Well, let’s do an award and get out of here because I have to pump, this is how I end every episode now. I have to pump. I have to pump. Okay.
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Today’s award is going to the British ultra-runner Sophie Power who was breastfeeding her three-month-old son, Cormac, at a rest stop 16 hours into 106-mile trail race. She says, and you know, she’s not a patron yet. I’d love her to be. I don’t even know if she’s a listener, but we just saw this and we were like, Sophie Power is a bad-ass.
Yeah. And her statement for a Runner’s world UK was, “oh my God. I was in agony. Cormac usually feeds every three hours and it took me 16 to get to Courmayeur where he could first meet me. So I was hand expressing everywhere I could on route. I was so relieved he was hungry.” Oh my gosh. She says, “in a typical race, I would get in and out of the aid stations as quickly as possible, but here I had to focus on keeping down enough food for me and Cormac and resting,” she said. She completed the intense race through France, Italy, and Switzerland in 43 hours and 33 minutes. Wow. Sophie, Sophie. Incredible. What the heck? Creative. Amazing. Oh, I bet your, your boobies were hurting 16 hours just running with them full.
Oh, I’m so sorry, girl. You did it though. You met that challenge and you freaking finished it. You ran through three countries. That’s incredible. 43 hours. Sophie, we are so proud of you. We just love that you are putting out there, your breastfeeding journey. I mean, at the time, maybe it didn’t feel like a movement to you, but by you sharing that experience, you really have created waves and ripples within our breastfeeding community.
And it’s very inspiring, very inspiring. So props to you. I hope you got some much-needed rest after. I hope your boobs are okay. I’m sure Cormac appreciates everything that you’re doing. And we appreciate you. So thank you for sharing. Okay. So Sophie, we are going to bestow upon you the Ultra Marathon Milker Award because you are an ultra-bad-ass.
You are. And I would love to say I’d like to follow in your footsteps, but that sounds exhausting. But I commend you for all of your steps. Well, everybody, thank you yet again, for listening to another episode of the Milk Minute Podcast. The way we changed this ginormous system that is absolutely not set up for lactating families is by educating ourselves, our friends and our children.
If you guys want more of us or merch or videos, or you really just want to give back because the podcast has made an impact on your life, please consider joining us on Patreon for as little as $1 a month. And if you can’t afford a monetary donation at this time, that’s okay. You can definitely tell a friend and that would be the best gift you could give to us.
And if you ever wanted to get in touch with us for any reason, even just to tell us a silly story, please email us at MilkMinutePodcast@gmail.com. All right, everybody. It’s been the happiest of Milk Minutes and I hope you have a great day. Bye-bye.
