By Jen Chandlee, CD(DONA), PCD(DONA), ICCE (ICEA), RYT200

In a time when the legalities of marijuana are rapidly changing, it is important for birth professionals to know how to respond to clients about the recreational and medicinal uses of this controversial plant. As a birth doula, postpartum doula and educator practicing in a very liberal city, I frequently encounter questions from students and clients about the safety of smoking, vaping, and eating pot during both pregnancy and breastfeeding. It can be challenging to provide good resources, as most of the studies that exist are old and poorly done (1). To make things more challenging, the legalities change from state to state, as do the policies and protocols of social service organizations; some are more lenient than others, and some hospitals are now administering universal testing of all mothers in labor.

History of Marijuana

But let’s back up a bit… the history of marijuana is important here, because it gives us a cultural context for how usage and politics have changed over time. In the early years of America’s history, hemp was grown by almost every farmer as an industrial crop, and marijuana was a popular ingredient in medicinal products including cough medicine, which were widely sold in public pharmacies. In the 1930’s with growing public concern over immigration, unemployment, racial and class divides, marijuana became misaligned and eventually outlawed. Then, in 1996, California passed a state law, in conflict with federal law, to allow the use of medicinal marijuana (2). Since then, many states have followed suit, and some have legalized the recreational use of marijuana as well.

We also need to address the changes in the marijuana plant itself. Today, marijuana is higher overall in THC than it was several years ago. Although the actual numbers vary, on average THC levels in the 1970’s were about 1%, and as of 2015 some strains were as high as 30%.

How Marijuana Interacts With the Body

This is problematic for babies, in part, because THC is a lipophilic substance and extremely fat soluble; it attaches easily to adipose (fatty) tissue, helping it to effectively “hijack” the endocannabinoid system (yes, we all have endocannabinoid, or EC systems!) in the brain. The EC system creates homeostasis by regulating many functions in the mind and body and naturally produces its own endocannabinoids, including one called anandamide- the bliss molecule. The molecular structure of anandamide is very close to that of THC which is why THC can fit so easily into the same brain receptors, thus taking over in its place. And this is why using marijuana causes feelings of hunger, short term memory loss, lack of coordination, paranoia, pleasure, etc. It is directly impacting those parts of the brain.

Available Research & Current Recommendations

In a developing fetus or a baby who is exposed to THC either through breast milk or by second hand smoke, this is a cause for concern, as we really don’t know how much marijuana it takes to have a negative impact on development. Some studies have clearly shown developmental impact, while other studies show very little impact (3).

Until additional research is available, where does this leave us as resource and support professionals? How can we provide evidence-based information, when it is almost impossible to come by? Laurel Wilson, IBCLC has done extensive research on the subject and suggests the non-judgmental Three-Step Counseling Approach (4):

  • Ask
  • Affirm
  • Counsel


When we ask, use open ended questions such as “how often are you using it, and why?”  or “do you feel that marijuana is safe because it is a plant?” Many women do, and it is important to explain that while marijuana may be a natural substance, it isn’t always safe to use. You could use the belladonna plant as an example of another plant that can be either medicinal or harmful, depending on when and why it is being used. In addition, you could ask her if she feels there might be a safer alternative to marijuana.


Then we affirm our client’s feelings (not necessarily the choice itself). For example, if she feels that marijuana is safe, you could affirm that some other women feel that way as well, or you can mirror back to her what she is saying “I hear that you feel that it is safe because it is a plant.” This helps her feel respected and heard.


Finally, we follow up with good counsel. We would counsel a very occasional user differently than a chronic, frequent one. We might point out the risks of social services becoming involved should someone report her for using. And we would certainly advise someone with a prescription for medical marijuana to follow up with her care provider to make sure her dosage is safe for pregnancy and breastfeeding, or if safer alternatives are available. Encourage them to weigh the risks versus benefits as we would with any medicine or intervention, and provide plenty of resources and information so that they can make their own best decision.

We can also share the recommendations of organizations which provide guidelines to medical care providers, such as the American College of Obstetricians & Gynecologists (ACOG) which in their July 2015 Committee Opinion on Marijuana Use During Pregnancy and Lactation (5) states:

“Studies using laboratory animals show that in utero exogenous cannabinoid exposure may disrupt normal brain development and function” and  “There are insufficient data to evaluate the effects of marijuana use on infants during lactation and breastfeeding, and in the absence of such data, marijuana use is discouraged.”

However, they do not recommend that breastfeeding be discontinued. The Academy of Breastfeeding Medicine (ABM) (6) offers a very similar recommendation:

“Information regarding long-term effects of marijuana use by the breastfeeding mother on the infant remains insufficient to recommend complete abstention from breastfeeding initiation or continuation based on the scientific evidence at this time.”

And The American Academy of Pediatrics (7) weighs in with this statement:

‘Maternal substance abuse is not a categorical contraindiction to breastfeeding…Street drugs such as PCP (phencyclidine), cocaine, and cannabis can be detected in human milk, and their use by breastfeeding mothers is of concern, particularly with regard to the infant’s long-term neurobehavioral development and thus are contraindicated.”

As with marijuana, alcohol was also illegal for a time but was later legalized again for recreational use. However, the legalities of a substance do not quantify its safety, therefore the current guidelines for marijuana and alcohol use are similar- they are not recommended for pregnancy or breastfeeding.


  1. Laurel Wilson; Marijuana and Breastfeeding webinar
  2. PBS- Frontline’s Marijuana Timeline
  3. Laurel Wilson; Marijuana and Breastfeeding webinar
  5. ACOG Committee Opinion, Issue Number 637, July 2015
  6. ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015
  7. AAP Policy Statement: Breastfeeding and the Use of Human Milk. 2012.

Additional Resources

About the Author

Jen ChandleeJen Chandlee was inspired to become a birth and postpartum professional in 1994 after having her first baby. Her extensive background and over 20 years of experience in the field allow her to provide women and their families a wide range of physical, emotional, and educational support offered with an open mind, loving hands, and calm presence. She is certified through DONA and ICEA.