Trading Xanax for ‘Natural’ CBD Oil — Is it Safe While Breastfeeding?
Sleepless, anxious new mom Sara Gaynes Levy had a prescription for Xanax. Then her friends started talking about cannabinoid oil as an alternative.
When my daughter was about five months old, she finally began sleeping through the night. Well, sometimes. Would this be a good night, or a bad one? We never knew.
That uncertainty generated an anxiety I’d never experienced before, and soon that was what was keeping me awake. Then the worry began to take over my daytime hours, too, as I obsessed about whether tiny decisions would have some kind of magical, predictive effect on the night’s outcome: did she sleep through the night the last time I wore these pajamas? Was it this lullaby or that one that did the trick? I was spiraling into full-blown insomnia, waking for the day around 3 a.m., even on nights my daughter continued to sleep soundly.
Intellectually, I believe there should be no shame or fear in treating mental illness.
So I went to a psychiatrist. He identified my problem as postpartum anxiety, gave me a list of cognitive behavioral strategies — deep breathing, tensing and releasing my muscles — and, for the nights when those techniques didn’t work, wrote me a prescription for Xanax.
The drug is fast-acting; if I took it at 3:30 a.m. after nursing, he reassured me that little would be left in my bloodstream when I nursed her again at 7 a.m. Even as I stood wobbling, exhausted, in line at the pharmacy, my daughter sleeping peacefully in her carrier on my chest, filling that prescription gave me pause. Intellectually, I believe there should be no shame or fear in treating mental illness, but as a wellness-lover and a breastfeeding mother — and as a woman who felt an irrational surge of pride when, after I donated my cord blood after my daughter was born, the technician at the hospital told me, “I don’t know what you’ve been eating, but your placental blood is amazing” — I struggled to internalize that message. I eat organic, run half-marathons, do yoga every Sunday. Taking a psychiatric pharmaceutical that comes with the potential for dependence does not fit the profile.
I was anxious all over again.
My wellness-obsessed friends shared my doubts — and, seemingly, were all onto the same miraculous alternative. One after another, they gently asked why I was choosing a prescription when I could take something like CBD oil, which, after all, comes from a plant, not a lab. Let me remind you of what you’ve probably already heard countless times in the roughly two years during which cannabinoid oil, aka CBD, has risen to GOOP-era stardom: It’s derived from the marijuana plant, but contains no THC (pot’s psychotropic element), and is said to induce an overall relaxed feeling — think chilled, not stoned. CBD is now, suddenly, available as an additive in coffee, cookies, and smoothies, not to mention skincare. Suddenly, I was anxious all over again, worrying about whether I was making the right choice for my own health, and my baby’s.
This is common enough in new moms, says Catherine Birndorf, MD, the cofounder and medical director at The Motherhood Center in New York City, which specializes in treating pre- and post-natal mood and anxiety disorders. “This idea kicks in that ‘I have to do better than just good enough,'” Birndorf says. “And that extends to not taking anything that’s a drug or perceived as ‘bad’ for you. “People think [CBD and the like] are safer because they’re ‘natural.’ But psychiatric drugs came from natural substances that we’ve figured out how to manufacture. And they’re more well-studied than probably anything else we put in our bodies,” she told me. “Psychiatric symptoms that are untreated have incredibly far-reaching implications — for the baby and you. And people are using illicit drugs or alcohol because they think somehow that’s better? No.”
We do know CBD is generally safe, but it’s also not well regulated.
Very little data exists on CBD oil at all — it may well relax you, but it’s unclear whether that’s due to a chemical reaction in the body or a (very real) placebo effect. “And in pregnant and breastfeeding moms, the clinical studies, the research — even survey research isn’t there,” says Martin De Vita, a doctoral candidate in clinical psychology at Syracuse University who studies CBD. “In general, there isn’t much clinical use. We do know CBD is generally safe, but it’s also not well regulated. Consumers should be careful.”
According to De Vita, early research indicates that using CBD during pregnancy might actually weaken the placental wall, making it easier for anything in your system (including CBD) to cross the barrier and affect a fetus. And while pure CBD oil should contain less than .02 percent THC, he says it’s possible that, because THC is stored in fat cells, even those trace amounts could bind to the fat in breast milk.
If I took CBD oil, I’d have no way of knowing how much was getting into my daughter’s system. With Xanax, we know this down to the microgram: 1.1 hours after I popped my 0.5 milligram dose, Xanax would have filtered into my breast milk at 3.7 micrograms per liter (or 0.11 micrograms per ounce, since no one measures breast milk in liters). The concentrations drops from there but, to be clear, Xanax has a long half life — some trace of is detectible in breastmilk for an average of 14.5 hours — which is why it would not be a first choice drug for many nursing moms. My doctor chose it for me because I took it infrequently — maybe once a week — and needed something that works really fast, since new moms are grabbing slivers of sleep between feedings. Plus, I always nursed her at least three hours after taking it.
Ultimately, I decided to save my experiments with CBD for when I’m no longer nursing. Eventually, my sleep anxiety subsided on its own. But for three months, I took that little white pill intermittently, and without fail, it did the trick — I slept. And though I was always watchful for possible side-effects, like vacantness, difficulty eating, and excessive sleeping, that would indicate my daughter had been exposed to the drug, I never picked up on even a hint of grogginess. Still, did I ever feel great about taking it? Not completely. Birndorf says that’s normal too — although we don’t talk about it nearly enough. “The reason people get dogmatic about parenting choices is because we don’t know,” she says. “It takes a lot of courage and confidence to admit, ‘I’m not sure, but this is how I do it.'”
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CBD and Breastfeeding: Is It Safe?
Pregnancy is one thing, but postpartum life often comes with a variety of mental and physical challenges. As many as one in five women suffer from postpartum depression, according to the Centers for Disease Control and Prevention (CDC). Other concerns include anxiety, chronic pain, and insomnia, all compounded by the lack of sleep and hormonal shifts that naturally occur after giving birth. It's no wonder more new parents are gravitating to CBD, or cannabidiol, a component of either a marijuana or hemp plant that is non-psychoactive (unlike THC, or tetrahydrocannabinol, which only comes from marijuana).
CBD has been touted as the active ingredient in a variety of therapeutic products that boast anti-inflammatory, antioxidant, anti-psychotic, anti-convulsant, and antidepressant properties. But is it safe to use CBD while breastfeeding? Here's what nursing parents need to know about CBD.
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What the Science Says About Using CBD While Breastfeeding
Research has focused primarily on THC, as opposed to CBD, in breast milk, and the conclusion is that it is possible to pass low levels of the psychoactive ingredient to your baby while nursing. A study published in the journal Obstetrics and Gynecology looked at samples of breast milk from eight anonymous test subjects who regularly use cannabis and found that babies who were three to five months old and who were breastfed exclusively ingested an estimated 2.5 percent of the maternal dose of THC. (Researchers didn't, however, take blood samples from the infants to see if they had measurable levels of THC in their bodies.)
And trying to "pump and dump" doesn't work for cannabis products, as chemicals from cannabis that entered the body days or weeks prior to breastfeeding can make their way into breast milk, according to Medical News Today. In fact, other research published in the journal Pediatrics found that low levels of THC may be found in breast milk for up to six days after smoking cannabis or eating an edible.
Granted, this research was done on marijuana and THC, not hemp and CBD. But experts are concerned about the effect of any cannabinoid on an infant's brain development.
"We truly do not know what short- or long-term impact on the baby it may have," says Felice Gersh, M.D., a board-certified obstetrician and gynecologist and author of
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Is CBD Safe While Breastfeeding?
"Having a new baby is stressful, and some may wish to turn to cannabis products," Dr. Gersh notes. But the limited data on its safety—and the fact that it will pass into breast milk—makes it difficult for many experts to advise its use for nursing parents. "Unfortunately, there is no safety data to allow a doctor to recommend the use of cannabis or CBD," says Dr. Gersh.
Mary Clifton, M.D., an internal medicine doctor in New York City agrees, stating, "If a new parent is breastfeeding, it's probably not wise to use CBD. The medical community doesn't support the use of CBD in these settings, because proper studies can't be completed on the effect on the baby or infant."
Despite the lack of published research, new parents have used cannabinoids for thousands of years, notes Robert Flannery, Ph.D, owner of Dr. Robb Farms. "Yes, THC and CBD are expressed in small quantities in breast milk," Dr. Flannery says. And while he doesn't feel comfortable suggesting CBD for a new parent who is breastfeeding, he acknowledges the use of cannabis in the past.
"We do not have enough research to make claims one way or another on how that breast milk would affect the milk-fed babies," says Dr. Flannery. "Cannabis is a medicine that has been used specifically for pregnant and breastfeeding parents for millennia. I will never make a claim without the science to back it up, but we should understand that anecdotal evidence can be used to formulate testable hypotheses to validate the use of cannabis at this time in a one's life."
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Risks Vs. Benefits of CBD While Breastfeeding
Ultimately, because CBD "has been shown to be little risk to both adults and children" and therefore, "may not pose a problem," it is important to weigh the risk versus benefits for the breastfeeding parent and the infant, says Hilary Peckham, the co-founder of Etain Health, the only all-women, family owned medical marijuana dispensary company in New York.
For instance, many new parents suffer from postpartum depression, anxiety, fatigue, mood swings and detachment from the infant. "Many sufferers start a treatment of antidepressants which may not be appropriate for breastfeeding and may need to be discontinued," Peckham says. "Starting CBD may still allow the parent to breastfeed and prolong the bonding time with the infant. That said, you should speak to your doctor before starting CBD, especially if you are breastfeeding."
The Bottom Line
The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) recommend physicians counsel parents to abstain from all cannabis products—including CBD—if they wish to breastfeed. However, given the minimal amount of the substance that make its way into breast milk, and the fact that research has yet to confirm the exact effects on an infant, anyone interested in trying CBD while nursing would do well to speak to their doctor.