Marijuana is the most commonly used illicit drug in the United States (National Institute on Drug Abuse [NIDA], 2018). Nationwide, 6% of pregnant women report marijuana use (Crume et al., 2018) with 5% of mothers continuing their marijuana use while breastfeeding (Crume et al., 2018). Professional guidelines established by the Academy of Breastfeeding Medicine (ABM)(Reese-Stremtan & Marinelli, 2015), the American Academy of Pediatrics (AAP)(American Academy of Pediatrics [AAP], 2012 and 2018), and the American College of Obstetricians and Gynecologists (ACOG)(ACOG, 2017) all agree that breastfeeding mothers should be screened for marijuana use and counseled based on existing evidence.
In the absence of knowing the status of the breastfeeding mother’s marijuana use, the opportunity to provide evidence-based counseling regarding substance use and its impact on both the mother and nursing infant’s health and milk supply is missed.
The purpose of this quality improvement project was to identify the degree to which breastfeeding mothers were using marijuana and to document evidence-based counseling on effects during breastfeeding. The project was accomplished by (1) training pediatric healthcare providers in evidence-based recommendations to breastfeeding mothers regarding marijuana use and (2) establishing an electronic system to facilitate provider counseling of evidence-based recommendations.
Primary findings were that breastfeeding mothers were not routinely screened at the two week well infant visit about maternal marijuana use and evidence-based counseling was not standardized. After provider training was delivered and electronic –associated reminder and evidence-based counseling was embedded into the health record, the percentage of breastfeeding mothers being screened about marijuana use increased by approximately 50%. Additionally,
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women who acknowledged marijuana use while nursing were given standard, evidence-based counseling regarding the effects of marijuana use while breastfeeding. It was concluded that provider education and ease of standardized documentation of provider counseling increased both maternal inquiry into marijuana use and provider counseling and documentation of evidence-based counseling.A one-year embargo was granted for this item
