Hospital breastfeeding policies for cannabis-using mothers are highly inconsistent across the US

For mothers with a positive cannabinoid screen at delivery, 16% of hospitals universally or selectively restrict breastfeeding. 96% of nursery directors considered marijuana use while breastfeeding somewhat (70%) or very (26%) harmful. No consistent associations were found between breastfeeding restrictions and provider knowledge, geographic region, or state legalization status.

Cross-sectional survey of 110 US hospital nursery directors in the Academic Pediatric Association BORN network. 69 (63%) responded across 38 states. The 31-question survey assessed policies, knowledge, and attitudes regarding marijuana use and breastfeeding.

Inconsistent hospital policies mean that whether a cannabis-using mother can breastfeed depends largely on which hospital she delivers at, not on evidence. This variability raises equity concerns and highlights the need for evidence-based national guidelines.

Breastfeeding provides well-established health benefits for infants, and restricting it has consequences. Without clear evidence-based guidelines on cannabis and breastfeeding, hospitals are making policy in a vacuum, leading to inconsistent care that may disproportionately affect certain populations.

Only BORN network hospitals surveyed, which may not represent all US hospitals. 63% response rate introduces potential selection bias. Director-reported policies may not reflect actual clinical practice. Survey did not assess outcomes for infants.