“Breast is best.” It’s the one piece of advice virtually every new mother hears. That advice often comes a cornucopia of guilt about what to eat, how to nurse, and how the wrong decision can harm the baby. Research shows that the majority of mothers want to breastfeed, but that most don’t meet their own breastfeeding goals. When you’re dealing with nipple pain, the endless demands of pumping, and night wakings, sorting through the research—and separating myth from reality—can be daunting. Many mainstream scientific bodies, including the U.S. Food and Drug Administration and the American Academy of Pediatrics, counsel against using CBD while breastfeeding. A deeper dive into the research, however, suggests that CBD may be safe—and that the risks of not breastfeeding far outweigh the risks of breastfeeding and using CBD.
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Can You Use CBD and Breastfeed?
To assess whether it’s safe to breastfeed while using CBD, the first thing researchers look at is the amount of CBD that gets into breastmilk. Unfortunately, most media reports and public health guides conflate CBD and tetrahydrocannabinol (THC), the psychoactive ingredient in cannabis. Others treat cannabis and CBD as comparable drugs, when the evidence shows that they are not.
Pure CBD oil should contain less than 0.2 percent THC. This means that—even if we operate from the assumption that cannabis and THC are harmful to babies–babies whose mothers use CBD are not exposed to THC at levels that are likely to affect their development or well-being.
No recent research has measured the quantity of CBD in breastmilk among mothers who use only CBD. However, a 2018 analysis of mothers who used cannabis found only minuscule amounts of CBD and THC in breastmilk. Other small studies have arrived at similar conclusions.
Dr. Jack Newman, who is perhaps the world’s best-known breastfeeding expert, has always counseled nursing women that very few medications require them to stop breastfeeding. Moreover, according to Newman, breastfeeding is so beneficial that doctors need to talk more about the risks of not breastfeeding. Put simply, it is usually safer to keep breastfeeding while navigating the minimal risks of medications like CBD.
On his website, Dr. Newman advises parents that neither THC and CBD are transmitted to the baby in large volumes via breastmilk. “Cannabidiol (CBD), is now used widely as treatment for various medical disorders (medical marijuana) and thus not really a drug of recreation,” Newman explained in an online article. “It has low oral absorption[;] less than 20% of the orally taken dose is absorbed.”
According to Newman, CBD and THC are both highly protein bound, such that only about 0.1% of the dose gets into milk. CBD is also poorly absorbed by the baby’s intestinal tract, such that a mere 6-20% of the drug consumed in breastmilk is absorbed. This means that the baby gets a fraction of a percent of the mother’s CBD dose—somewhere in the range of 0.006% to 0.02%. Even if one assumes that CBD is harmful to babies—an assumption not rooted in clear scientific evidence—such a small dose is unlikely to cause harm.
The Confusing State of CBD and Breastfeeding Research
The research on CBD use and breastfeeding is a confusing morass of misleading and incomplete data. Most of the studies that the FDA and similar bodies cite have looked not at CBD, but at cannabis. Cannabis contains numerous active compounds, including CBD, so any research that assesses cannabis rather than CBD will necessarily inflate the risk and confuse CBD with other chemicals.
Even more importantly, the FDA extrapolates data from cannabis use during pregnancy and applies it to breastfeeding. The biology and metabolism of breastfeeding and pregnancy are completely different because many substances used during pregnancy cross the placenta, while few enter breastmilk in significant quantities. Something that is wildly unsafe during pregnancy is often completely safe when nursing.
Consider alcohol, for example. There is no safe level of alcohol consumption during pregnancy, but moderate drinking while breastfeeding is completely safe. It is impossible to determine whether something is dangerous when nursing based on research conducted during pregnancy.
An American Board of Obstetrics and Gynecology-certified attending physician at Swedish Hospital in Seattle cautions women that no one can offer certainty about the potential risks or benefits of breastfeeding while using CBD.
“Unlike THC, there just haven’t been lots of published studies,” she explained. “Doctors are telling women to stay away from CBD until we know more. Supplements like CBD are just not subject to the rigorous investigations that pharmaceuticals face.”
So what’s a nursing parent to do? For now, there is no research that shows any specific harm associated with CBD use. But there is plenty of research linking CBD to improvements in maternal well-being and general health. Like all parenting decisions, then, the decision to use CBD requires parents to weigh risks and benefits while accepting a degree of uncertainty.
How CBD Can Support Breastfeeding
The American Academy of Pediatrics recommends that mothers nurse exclusively for the first 6 months, continue nursing until 12 months, and then keep nursing for as long as mutually desirable after that. The World Health Organization recommends breastfeeding for 2 years or longer. Many nursing mothers quickly discover a world that is hostile to these goals. They struggle with pain, with pressure from family members to stop, with fatigue, night wakings, and growing anxiety.
CBD may help women manage the myriad challenges of nursing and meet their feeding goals. Most moms who stop breastfeeding cite supply issues or concerns about infant satiation. While there is no peer-reviewed evidence on this topic, some pediatricians and lactation consultants recommend CBD drops to improve breastmilk supply. CBD may help stimulate breastmilk production by easing anxiety, supporting healthy hormonal balance, or by some other yet-to-be-identified mechanism.
For women who experience pain—either nipple pain from a bad latch or chronic pain from supporting a heavy baby—CBD also offers hope. An avalanche of evidence suggests that CBD oil can ease both acute and chronic pain, helping women weather the storms of early breastfeeding.
For many women, nursing adds to the immense stress of new parenthood. They may have to juggle pumping at work, listen to unwanted advice from family members, or face stigma when they choose to nurse in public. CBD has been repeatedly shown to ease symptoms of anxiety, potentially helping nursing mothers better deal with the stress of breastfeeding.
Taken together, these benefits suggest that CBD isn’t just harmless. It can actually improve the experience of early parenthood while helping babies reap the many benefits of breastmilk.
Whom Should You Believe?
So much of the advice new parents receive is rooted in ideology, not science. A few generations ago, doctors routinely advised women not to breastfeed. The pendulum constantly swings back and forth on newborn sleep strategies, and everyone has an opinion on how babies learn best.
Advice about CBD use during breastfeeding is no different. Well-meaning doctors want to keep babies safe, so may advise women to abstain from CBD. Government entities still routinely advocate for legal bans on CBD and cannabis, so must tell women that CBD is dangerous. Women are left to sort through the morass of research on their own, and it can be difficult to discern whom to believe.
There are three key takeaways for breastfeeding mothers who want to use CBD:
- There is no conclusive research linking CBD use during nursing to negative outcomes in infants.
- Medical providers must advise women to minimize risk, and therefore will almost always tell them to abstain from CBD. This doesn’t necessarily mean that there is any specific, proven risk associated with CBD use.
- The benefits of breastfeeding are myriad. Researchers have identified hundreds of ways breastfeeding protects a baby’s health. Quitting breastfeeding may be harmful to a child’s health.
Parents who are interested in trying CBD should ensure they use a pure oil from a reputable brand. Start with a low, infrequent dosage and monitor the baby for any side effects. Because CBD may remain in breastmilk for many days, there is no benefit to pumping and dumping right after using CBD.
Parenting is hard, exhausting, often thankless work. No wonder so many parents feel overwhelmed, anxious, or depressed. A healthy baby needs healthy parents. Depriving parents of medication that improves their well-being, including CBD, may therefore actually be harmful. As with any medication, consult a doctor or other health provider who is knowledgeable about CBD use and breastfeeding, and who understands the role both play in good health.