By MGH Center for Women's Mental Health | May 5, 2021
"At this point, nine states and Washington, DC have legalized the use of recreational marijuana. Another 30 states have legalized medical marijuana. The downstream effect of these changes has been a significant uptick in the use of cannabis among women of childbearing age. According to data collected from the National Survey on Drug Use and Health, the use of cannabis in pregnant women rose from 2.37% in 2002 to 3.85% in 2014 in the United States, noting that 21.1% of pregnant women who used cannabis reported doing so on a daily basis.
While we have data to indicate that the use of cannabis during pregnancy may negatively affect fetal growth and brain development, we have less information on how the cannabis and its byproducts, which are secreted into the breast milk, may affect the nursing infant. Here are some important things we do know:
Can cannabis be found in the breast milk?
No matter how marijuana/cannabis is consumed (smoking, vaping, or ingesting), its byproducts can be found in the breast milk. Figuring out how much is passed into the breast milk is complicated because how women use cannabis varies considerably. For example, the kinetics of smoking vary considerably from ingesting. Both cannabidiol (CBD) and the psychoactive component, delta-9-tetrahydrocannabinol or THC, have been detected in breast milk.
In the largest study to date, which included eight breastfeeding women, the amount of THC detected in pumped breast milk ranged from 0.4%-8.7% of the maternal dose, with an estimated mean of 2.5%. Using these data, the average absolute infant dose was estimated to be 8 micrograms per kilogram per day.
If cannabis is consumed, how long does it persist in the breast milk?
Cannabis concentrations in the breast milk are variable and are related to maternal dose and the frequency of dosing. However, there are some things that make cannabis a little different than alcohol or other recreational drugs. Cannabis and its byproducts are very fat-soluble or lipophilic. Because in women the percentage of body fat is 25-30%, there is a large reservoir for the storage of cannabis. What this means is that it takes much longer for cannabis to leave one’s system, compared to substances like alcohol. Furthermore, there is an especially long washout period in those who have been daily users. Long after the psychoactive effects have faded, THC and its metabolites can be detected in blood, urine, and breast milk.
Studies focusing on the detection of THC in milk have yielded variable results, with duration of detection ranging from 6 days to greater than 6 weeks in various studies. The most recent study from Wymore and colleagues In a recent study, Wymore and colleagues collected data on self-reported marijuana usage and measured levels of THC in maternal plasma and breast milk samples several times a week. In all 25 participants, THC was detectable in breast milk throughout the six week duration of the study.
The researchers estimated the mean half-life of THC in breast milk to be 17 days (SD 3.3). Based on this estimate, they calculated that it would be possible to detect THC in breast milk for longer than 6 weeks. In addition, the researchers were able to calculate a milk:plasma partition coefficient for THC which was approximately 6:1 (IQR, 3.8:1 – 8.1:1). Milk:plasma ratios give us a sense of how easily a compound passes from the mother’s bloodstream into the breast milk and can be used to estimate the amount of exposure through breast milk. Most M:P ratios for drugs commonly used in breastfeeding women are around 1 or less than 1; thus, an M:P ratio for THC of 6 is high and suggests that levels of THC in the breast milk may be higher than in the mother’s bloodstream.
The findings of the Wymore study are consistent with previous studies measuring THC in breast milk which observed a duration of detection ranging from 6 days to greater than 6 weeks after using cannabis. The longevity of THC in the breast milk may be related, in part, to the extremely high fat content of breast milk and the lipophilic nature of THC, so that the breast milk “traps” the THC, in a sense acting like a reservoir for THC storage.
What are the effects of exposure to cannabis in the nursing infant?
The bioavailability of cannabis and its metabolites ingested by neonates in the breast milk has not been well-characterized. There are conflicting data regarding the outcomes of infants exposed to cannabis during breastfeeding and very few studies assessing outcomes in this population. These studies are not easy to conduct. First of all, recreational use of cannabis continues to be illegal in many states. Furthermore, it is difficult to disentangle the direct effects of cannabis delivered in the breast milk from the indirect effects of cannabis on the quality of childcare and parenting, especially in heavy, chronic users or when cannabis is combined with other substances.
In one study, 136 breastfeeding infants were assessed at one year of age. In the 68 infants exposed to cannabis during the first month of life, there was evidence of decreased motor development at one year, when compared with matched infants who were not exposed to cannabis. Specifically, there was a 1465-point decrease in the Bayley index of infant motor development. However, the authors of this study cannot conclude that these findings were entirely due to exposure via breastfeeding, as many of the women also used marijuana during pregnancy.
In another study, 27 breastfed infants exposed to cannabis were compared to 35 unexposed breastfed infants. At one year, no differences were noted for motor and mental development using the Bayley Scales of Infant Development. However, the small size of this study limited statistical analysis.
So the jury is still out regarding the effects of cannabis on the nursing infant.
All women should be screened for drug use as a component of standard prenatal care. Screening for substance use should occur during the course of pregnancy with the goal of providing information regarding the potential adverse effects of cannabis and to ensure referral to appropriate resources for treatment as needed. Because many women are able to abstain from substances during pregnancy but resume use after delivery, screening must be repeated during the postpartum period.
Both the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics recommend that women refrain from using cannabis during pregnancy and while breastfeeding. Because of the persistence of cannabis and its byproducts in the breast milk for days to weeks, using cannabis and waiting for it to clear out of the breast milk is not a viable option. For women who use cannabis for medical indications, alternative therapies with more safety data during breastfeeding should be considered."
-Ruta Nonacs, MD PhD
By: Shanicia Boswell | August 26, 2020
"Raising awareness about the history of Black breastfeeding and the factors that contribute to low rates of Black mothers breastfeeding is an important way to close the gap."
"I sat on the sofa crying silently between my mother and my fiancé. Tears spilled over my cheeks as we watched a movie and I held my newborn daughter. I was three days postpartum and my breasts were painfully engorged with milk. How was this happening? I had survived a med-free labor and delivery. This was supposed to be the easy part. Looking back nearly eight years ago at my breastfeeding journey, I always remember this day. I was a first-generation breastfeeder.
That day and many other days, I sat between people I loved the most and felt completely alone and isolated. My partner could not help me with breastfeeding because he was a man who had no experience around breastfeeding. My mother could not help me because she had not breastfed me or my brother. My friends could not help me because I was the only one in my friendship circle who had a baby. Like many Black millennial women, I was embarking on this journey alone.
Without the proper resources, my breastfeeding journey only lasted six months. I felt defeated. In fact, the statistics show that Black women are less likely to start breastfeeding than any other race of mother and even less likely to continue breastfeeding for six months. Only 69 percent of Black women initiate breastfeeding compared to 85 percent of white women. The question that is often asked after hearing statistics is why? There are many reasons. There are unfortunate events deeply connected to our race as a people: a history of wet nursing, oversexualization, lack of economic and familial support, are a few. For me, the question became how do we raise the numbers?
This is where Black Breastfeeding Week comes in. Black Breastfeeding Week is August 25 to 31, 2020, and is a campaign that has been part of National Breastfeeding Month for the past eight years. This year, through virtual events, Black mothers, lactation experts, and public health professionals have space to discuss their breastfeeding journeys, raise awareness, and explore public policies that address the disparities in statistics around Black maternal and infant care. Black Breastfeeding Week has become even more controversial this year because we are in a time where extreme emphasis has been placed upon race and it creates a space where white mothers feel isolated. White mothers are asking why Black women are choosing to segregate themselves, even down to the topic of breastfeeding.
As the creator of Black Moms Blog, a collaborative blogging platform for mothers of color, I am no stranger to the "why aren't we included" questions from white mothers. The truth is, weeks like this should not have to exist. Platforms like mine should not be a necessity—but they are. The needs of Black mothers as well as the specific barriers we face are left out of the overall breastfeeding conversation. The historical and cultural context as to why is important.
The History of Black Breastfeeding
Cultural reference should always be considered when discussing breastfeeding. During slavery, Black women were used as wet nurses. A wet nurse is someone who breastfeeds another woman's child. The true definition of a wet nurse states "employed," but replace that word with "forced," and the reality becomes clear. It is generational that Black women have developed a disdain for breastfeeding due to our historical relationship with wet nursing. Because of wet nursing, many Black women were unable to breastfeed their own children. Can you imagine the psychological effect that must have had on a moment that every mother should enjoy?"
Dutch News| August 19, 2020
"Researchers at Amsterdam’s UMC teaching hospital and a number of other institutes have found coronavirus antibodies in the breast milk of women who have tested positive for the virus.
The research team are now looking into whether the milk could be used to prevent coronavirus infections in vulnerable people during an eventual second wave, possibly in the form of flavoured ice cubes.
hey have already found that the antibodies are not destroyed by pasteurising the milk, which is necessary to make it usable by other people.
"We think when drinking the milk, the antibodies attach themselves to the surface of our mucous membranes,’ Hans van Goudoever, head of the Emma children’s hospital at the UMC, said. ‘Then they attack the virus particles before they force their way into the body."
The UMC has now started a campaign to find 1,000 women who are willing to donate 100ml of breast milk for the research project. ‘Women who may have had coronavirus without noticing it may also have made antibodies which can be found in milk,’ Van Goudoever said. ‘So we are looking for mothers who may have been infected as well.’ Even if this turns out not to be the case, their milk can be stored for further research, if they give permission, he said.
Women who want to take part are urged to contact email@example.com."
Reviewed by: Lisa Hollier, MD, MPH, FACOG, Baylor College of Medicine, Houston, Texas
"Please note that while this is a page for patients, this page is not meant to give specific medical advice and is for informational reference only. Medical advice should be provided by your doctor or other health care professional."
"What is COVID-19?
COVID-19 is a new illness that affects the lungs and breathing. It is caused by a new coronavirus. Symptoms include fever, cough, and trouble breathing. It also may cause stomach problems, such as nausea and diarrhea, and a loss of your sense of smell or taste. Symptoms may appear 2 to 14 days after you are exposed to the virus. Some people with COVID-19 may have no symptoms or only mild symptoms.
How does COVID-19 affect pregnant women?
Researchers are still learning how COVID-19 affects pregnant women. A report released in June 2020 looked at whether pregnant women might be at increased risk of getting very sick from COVID-19. This report from the Centers for Disease Control and Prevention (CDC) notes that:
How can COVID-19 affect a fetus?
Remember that researchers are learning more about COVID-19 all the time. Some researchers are looking specifically at COVID-19 and its possible effects on a fetus. Here’s what they know now:
What should pregnant women do to avoid the coronavirus?
Pregnant women should take steps to stay healthy, including:
Should pregnant women wear a mask or face covering?
As of April 3, the CDC says all people, including pregnant women, can wear a cloth face covering when they are in public to slow the spread of COVID-19. Face coverings are recommended because studies have shown that people can spread the virus before showing any symptoms. See the CDC’s tips on making and wearing a face covering.
Wearing a cloth face covering is most important in places where you may not be able to stay 6 feet away from other people, like a grocery store or pharmacy. It also is important in parts of the country where COVID-19 is spreading quickly. But you should still try to stay at least 6 feet away from others whenever you leave home.
If you have COVID-19 or think you may have it, you should wear a mask while you are around other people. You also should wear a mask if you are taking care of someone who has COVID-19 or has symptoms. You do not need to wear a surgical mask or medical-grade mask (N95 mask).
How will COVID-19 affect prenatal and postpartum care visits?
It is important to keep your prenatal and postpartum care visits. Call your obstetrician–gynecologist (ob-gyn) or other health care professional to ask how your visits may be changed. Some women may have fewer or more spaced out in-person visits. You also may talk more with your health care team over the phone or through an online video call. This is called telemedicine or telehealth. It is a good way for you to get the care you need while preventing the spread of disease.
If you have a visit scheduled, your care team’s office may call you ahead of time. They may tell you about telemedicine or make sure you do not have symptoms of COVID-19 if you are going in to the office. You also can call them before your visits if you do not hear from them."
"The process of weaning involves hormonal, psychological, social, and physical changes."
By Cassie Shortsleeve| June 08, 2020
"Last month, one random morning while breastfeeding my 11-month-old daughter Sunday, she bit down (and laughed) then tried to latch back on. It was an unexpected snag in an otherwise smooth breastfeeding journey, but after some bleeding (ugh), a prescription antibiotic ointment, and shedding some tears, I decided it was also the end.
Not only did I beat myself up—I didn't make it to the (albeit self-imposed) one-year marker that I had set—but within days, those teary, dark moments that had been with me in the early postpartum period crept back up. I could almost feel my hormones changing.
If you just had a baby (or have new mom friends), you're likely aware of some of the mood changes that can accompany new parenthood, namely the "baby blues" (which impact some 80 percent of women in the weeks following delivery) and perinatal mood and anxiety disorders (PMADs), which impact some 1 in 7, according to Postpartum Support International. But mood issues related to weaning—or transitioning your baby from breastfeeding to formula or food—are less talked about.
In part, that's because they're less common than PMADs, such as postpartum depression. And not everyone experiences them. "All transitions in parenthood can be bittersweet and there is a wide array of experiences associated with weaning," explains Samantha Meltzer-Brody, M.D., M.P.H., director of the UNC Center for Women's Mood Disorders and a principal investigator in the Mom Genes Fight PPD research study on postpartum depression. "Some women find breastfeeding very satisfying and do experience emotional difficulty at the time of weaning," she says. "Other women do not experience emotional difficulty or they find weaning to be a relief." (See also: Serena Williams Opens Up About Her Difficult Decision to Stop Breastfeeding)
But mood changes related to weaning (and *everything* breastfeeding, TBH) make sense. After all, there are hormonal, social, physical, and psychological changes that take place when you stop nursing. If symptoms crop up, they can also be surprising, confusing, and occur at a time when you may have *just* thought that you were out of the woods with any postpartum woes.
Here, what's going on in your body and how to ease the transition for you.
The Physiological Effects of Breastfeeding
"There are basically three stages of hormonal and physiological changes that allow women to produce breastmilk," explains Lauren M. Osborne, M.D., assistant director of the Women's Mood Disorders Center at The Johns Hopkins University School of Medicine.
The first stage happens in the second half of pregnancy when the mammary glands in your breasts (which are responsible for lactation) begin to produce small amounts of milk. While you're pregnant, super high levels of a hormone called progesterone produced by the placenta inhibit the secretion of said milk. After delivery, when the placenta is removed, progesterone levels plummet and levels of three other hormones—prolactin, cortisol, and insulin—rise, stimulating milk secretion, she says. Then, as your baby eats, the stimulation on your nipples triggers the release of the hormones prolactin and oxytocin, explains Dr. Osborne.
"Prolactin brings a feeling of relaxation and calmness to mom and baby and oxytocin—known as 'the love hormone'—helps with attachment and connection," adds Robyn Alagona Cutler, a licensed marriage, and family therapist who specializes in perinatal mental health.
Of course, the feel-good effects of breastfeeding are not just physical. Nursing is an extremely emotional act in which attachment, connection, and bonding can be cultivated, says Alagona Cutler. It's an intimate act where you're likely snuggled up, skin-to-skin, making eye contact."
By Carmela K Baeza, MD, IBCLC| Art By Ken Tackett
"Some dyads (mother-infant pair) start their breastfeeding relationship in harsh circumstances. Frequently, due to medicalized births and unfavorable hospital routines, there are so many interferences to initiate breastfeeding that by the time mother and baby arrive home they are already using bottles and formula – despite mother having desired to exclusively breastfeed.
These mothers often feel that they do not make enough milk and that their babies prefer the bottle. They will make comments like “my baby doesn't like my breast”, “I cannot make enough milk”, “the more bottles I give my baby, the less she likes me”, and so on. This can become the road into postpartum depression.
Those mothers who are intent on breastfeeding will often look for support, and may find it in a midwife, a lactation consultant or a breastfeeding support group. These health care professionals or counselors may offer the mother to work on her milk production by expressing milk from her breasts (either with her hands or with a pump) and feeding that milk to the baby, as well as putting baby on the breast.
And this is what we call triple breastfeeding.
Imagine: mother puts baby at her breast. Baby suckles for an hour and a half, falling asleep frequently. Mother will tickle him, speak to him, encourage, often to little avail. After an hour and a half, mother will unlatch the baby (he never seems to come off on his own), put him in the crib, set up her breast pump and begin pumping, going for at least 15 minutes on each breast. Halfway through, the baby wakes up and cries – he´s hungry. But he was just on the breast for almost two hours! Mother turns off the pump (and so little milk has come out!) and feeds her baby a bottle of formula. She cries. She feels exhausted, useless, and unable to meet her baby´s needs. She has not left the house for days, because she is immersed in a never-ending cycle of breast-pumping-feeding."