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Table 3 Language in prenatal records related to marijuana use and breastfeeding: themes, representative quotes, and implications

From: Patient caught breastfeeding and instructed to stop: an empirical ethics study on marijuana and lactation

Theme Representative quotes—author/context Implication
Misinterpreting policy Pediatric NP in to see patient and inform her that she can no longer breastfeed due to positive tox for THC—postpartum nursing note Evidence that policy to avoid marijuana use while breastfeeding has been misinterpreted to avoid breastfeeding.
Advised patient that stopping smoking THC is beneficial for her and baby. Advised breastfeeding is not recommended for mothers who use THC … social work referral made—new OB intake visit nursing note
Reviewed decreasing THC use, pt is ‘attempting to do’… Pt aware she would not be able to breastfeed after delivery and SW would be involved if + urine tox at admission. Pt aware and will try to curb THC habit—antepartum social work note
Utox positive for THC: seen by SW postpartum. Avoid breastfeeding—postpartum physician note
Mom THC + on admit; express/discard until milk is safe 2 feed…pt aware of need to avoid THC exposure to infant—postpartum lactation consultant note
Medicinal use Patient states that she uses THC for her nausea and vomiting. States that she vomits up to 3 times every AM—nurse triage note The risk-benefit discussion of marijuana use is nuanced considering secondary or tertiary underlying and related issues.
Continues to admit to smoking marijuana, claiming that it helps her with increasing her appetite—antepartum social work note
Self-reports that she has experienced depression in the past, and has brought it up during past appointments with primary care doctors. She claims she never have been formally diagnosed or treated... Per the pt, she copes with her stress by smoking marijuana—antepartum social work note
Does admit to marijuana use secondary to headaches after her stroke—new OB provider note
Endorses self-medicating with marijuana daily, and states it is helpful in reducing her stress and anxiety—antepartum provider note
She is currently an everyday, several times a day marijuana smoker. She states it is the only thing that works to help with her nausea and her anxiety at this time. I reminded her that she has not been seen by a doctor yet to maybe prescribe her a legal and more healthy option to manage these 2 things—new OB nurse intake note
She reportedly smokes marijuana to help alleviate and cope with her current situational stressors (homeless, limited social support)—antepartum social work note
Punitive language Parent informed of need to discuss her history of substance abuse with Baltimore city CPS intake to determine a need for CPS intervention prior to maternal/newborn discharge. Parent is very anxious around pending CPS intervention and fearing removal postpartum social work note
…no intervention would be required based on lack of a positive tox on delivery
CPS intake worker
She states no MJ use since leaving [addiction medicine program], but we don't have the utox results
antepartum provider note
Despite not meeting legal requirements for Child Protective Services (CPS) referral, the patient was threatened with investigation and experienced anxiety surrounding the possibility of custody loss.
This is an example of language that discredits the patient’s testimony.
Discussed the implications of on-going substance abuse during pregnancy such as allegation of neglect leading to CPS intervention at delivery—antepartum note This demonstrates power dynamic between patient and care system, highlighting punitive effect.
Baby is NOT CLEARED until further notification from Baltimore City CPS. Social work will follow-up—postpartum social work note
Advised that she will possibly be sent to social work to address THC use during her next clinic visit—new OB nurse intake note
Withholding support Patient restricted from breastfeeding immediately following delivery due to urinary toxicology screen positive for THC.
Postpartum note 3 months after delivery: she did not breastfeed after delivery but desires to start now. Pt asking for prescription meds to help produce lactation…discussed she may not be able to stimulate since she never breastfed
Limited breastfeeding support during labor/postpartum admission directly affected this patient’s ability to breastfeed her infant despite her expressed desire to do so.