Cannabis and Lactation: Four Keys for Counseling

How common is cannabis use during pregnancy and lactation? Recent studies indicate that it is one of the most commonly used psychoactive substances during both. One in 20 pregnant people and 6.6 percent of lactating people report using cannabis, and experts believe these numbers are underestimates.

And in both groups, cannabis use is on the rise.

The result: chances are you are already encountering clients in your role as a lactation care provider who use cannabis, or you will in the future.

Will these clients feel comfortable asking for your advice on this potentially sensitive issue? If they do ask, will you know how to answer?

Below, we share four keys to counseling lactation clients about cannabis use — with expertise, awareness, respect, and sensitivity.

Counseling Key #1: Become a trusted resource. Discussing cannabis use can be scary for pregnant and lactating parents — fears about stigma or social services involvement are very real. So the first step in offering sound counsel is to make sure you are someone parents trust enough to discuss cannabis with in the first place. How?

First, acknowledge any assumptions and biases you may have about cannabis and examine them carefully. Understand that the history of cannabis is rooted in racism and elitism, which has a profound effect on how its use is viewed and treated today.

If a client brings up the topic of cannabis use, think carefully about your word choices and body language as you respond. Remain open and nonjudgmental as you offer straightforward, evidence-based information. Make sure your client knows you are part of their team, working together to safely meet their feeding goals.

Counseling Key #2: Know your cannabis facts. In a nutshell: THC is the most psychoactive compound in cannabis, and the one of most concern for lactation.

Because cannabis is highly lipid soluble, highly protein bound, and has a large volume of distribution, when a lactating parent uses cannabis, the relative infant dose (RID) found in their milk is low.

Despite cannabis’s low RID, however, there is currently not enough data to say that it is safe during lactation. Therefore, using cannabis during lactation is not recommended.

Completely eliminating use, though, is not desirable or realistic for every lactating parent. A more helpful goal can often be cutting back on use and reducing exposure for their infant. As a lactation care provider, you are in an ideal position to help with both.

Counseling Key #3: Share ways to reduce baby’s exposure. There are several ways a parent can meaningfully reduce the risks to their baby while still keeping the focus on providing their milk, and they are similar to those used to reduce nicotine exposure.

Advise them to avoid using cannabis in proximity to their baby, to use outside, and to change their clothes and wash their hands after use before holding their baby.

Exposure can also be reduced by timing use around breast/chestfeeding. Milk levels of cannabis peak 60 minutes after use and are low after four hours. Whenever possible, help them create a plan to choose their nursing times accordingly.

Counseling Key #4: Help identify alternatives to cannabis. If your client’s goal is to reduce their cannabis use during lactation, you can help. The first step is to understand their reasons for use. Some of the most commonly cited reasons are symptom management, coping, pain, anxiety, and depression.

It may be helpful for your client to know that many medications for anxiety and depression are compatible with lactation, and you could also help arrange a referral to a healthcare professional who can discuss their unique symptoms and needs.

You can provide support and suggestions for considering other coping strategies, self care, or alternative modalities, such as talk therapy, massage, or acupuncture, that might be realistic and effective for your client to reduce reliance on cannabis.

This information is drawn from our course “Cannabis Use During Lactation.” Instructor Leslie Southard, PharmD, BCACP, CBS, a pharmacist and Certified Breastfeeding Specialist with a career focus on medication use in lactation, offers a comprehensive look at the history, pharmacokinetics, recommendations, and latest research on cannabis.