Weed’s Last Taboo: Pregnancy

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Modern motherhood is a marvel and a minefield. An obstacle course of risk-reward calculations for which we will be judged. And pregnancy serves a sort of boot camp, with every decision feeling more monumental than the last, as a legion of friends, family, caregivers, influencers, and experts (real and imagined) readily dispense opinions on all of it. Sushi. Unpasteurized cheese. Cold cuts. Cardio. Retinol. Highlights. Gardening. Wine.

Weed?

It was Tara’s midwife who suggested it, actually. When Tara, a 31-year-old Los Angeles–based psychotherapist whose name isn’t really Tara, became pregnant, she could not stop vomiting. She thought some of her nausea was psychological — it was a mid-pandemic unplanned pregnancy — and some probably not. Her mom had suffered similarly throughout pregnancy. She had tried vitamin B6 and Unisom (a popular combination for treating nausea), acupuncture, IV drips, and ginger candies. Nothing worked.

“I had to take care of myself,” explains Tara, who had smoked weed since college. “I was desperate and so I just did what I knew would work.” Her midwife recommended vaping. Tara prefers a pipe, so they compromised on a bong, after her midwife suggested it would produce less carcinogens. “I was 13 weeks pregnant, taking bong rips for breakfast.”

Before the bong rips, Tara had been vomiting upwards of seven times a day. “I felt like I was hung-over, all day, every day,” she says, describing the first several months of her pregnancy. “I fucking thrived after I felt better. I had the bestpregnancy — like, glowing. Nobody knows, really, but people were just like, ‘You look amazing.’ And I’m like, ‘Oh, thank you, if you only knew, I was such a stoner.’”

When it comes to cannabis, the risk-reward stakes can feel outlandishly high. The rewards, for some, can be the difference between months of extreme nausea, pain, or crippling anxiety, and a relatively smooth pregnancy. The risks, however, are no less than losing one’s baby to the child-welfare system. Lindsay Ridgell, an Arizona woman who treated her extreme nausea during pregnancy with cannabis, was placed on the state’s child-abuse registry for alleged neglect when her newborn tested positive for exposure in 2019, and subsequently fired from her own job as a social worker for Arizona’s Department of Child Safety. Alabama’s chemical-endangerment law, originally conceived to keep children from dangerous places such as meth labs, has since expanded to include fetuses. That means a person who tests positive for THC while pregnant can be arrested, charged, and sent to jail, as a 20-year-old mother was in 2016, in lieu of a $2,500 bond.

Child-welfare and cannabis laws, and their interpretations, differ widely from state to state, and even hospital to hospital. New York, Texas, and New Mexico have all passed laws separating child abuse from cannabis use. Of course, there are potential health risks, too, but with an evolving slate of scientific research about the plant’s effects on developing fetuses and breastfeeding babies, we are still learning exactly what, and how serious, they may be.

While legal cannabis in the U.S. is now a $25 billion business — and women account for about one-third of the market — when it comes to pregnancy, the topic is still too stigmatized and, in some cases, too dangerous for patients to discuss with their caregivers. The result: systemic racial inequity, spotty scientific research, and a damaging culture of mistrust, fear, and silence.

That’s not to say that pregnant people aren’t consuming cannabis. Use in pregnant women more than doubled between 2002 and 2017, according to data from the National Survey on Drug Use and Health, and a more recent study from Kaiser Permanente in Northern California showed that the rate of use in early pregnancy rose by about 25 percent during the pandemic.

I was 13 weeks pregnant, taking bong rips for breakfast.

A robust community of “cannamoms” discusses their use in Facebook groups, sub-Reddits, Instagram comments, and private chats. A Clubhouse roundtable about breastfeeding and cannabis had no fewer than 500 attendees at 11 a.m. (8 a.m. Pacific!) on a Sunday morning last November. When I posed the question of weed in a doula-led private Telegram group of about 120 mostly Los Angeles moms, a handful piped up immediately saying they used it while breastfeeding; others said they were dying to, but afraid.

Many of the women who spoke to me for this story — even those who only considered consuming cannabis while pregnant or breastfeeding — asked that I only use their first names, or a different name altogether. Even Tara, the self-described stoner who now has a thriving daughter, said she still has told only a select few people that she smoked while pregnant.

“There’s just such a feeling of shame around cannabis use, especially when pregnant, especially when breastfeeding,” she says. “And I just didn’t want to deal with the judgment, but I also really wanted to get relief. So I was like, ‘I’m still gonna do it. But I’m just not going to tell anybody.’”

And for every Tara I spoke to, there were scores more women desperate to use cannabis — often because they knew it would help alleviate extreme nausea — but too afraid. Like Lisa, a pastry chef who left her job in a commercial kitchen in her first trimester when the smells became too nauseating to bear. Occasional hits from her husband’s vape pen had helped Lisa manage her chronic motion sickness before she became pregnant. But when she asked her OB/GYN whether there was any cannabis dose or type that could be safe, “she said, ‘I’m sorry, there’s just no research for me to be able to give you that clearance,’” Lisa remembers. Instead, the doctor sent her home with a prescription for Diclegis, a medication she described as more safety-tested than prenatal vitamins. Lisa took the pills but soon started to show symptoms of anxiety, depression, and insomnia.

“I would sit in an armchair and just be gripping the arms of the chair and try to put something on TV to just try to escape how I was feeling,” she said. “Every couple hours, I would try to get up and force myself to eat something. And that’s what the first half of my pregnancy looked like.”

Lisa chalked her feelings up to hormones, but later learned they were possible side effects of her pills. Her doctor was right, of course, that Diclegis has been FDA-approved, whereas cannabis has not been. Millions of women have used Diclegis, which was anointed with the FDA’s rare A-letter grade indicating the drug was studied in pregnancy and found to pose no risk to the fetus in the first trimester. (Kim Kardashian West has also promoted it on Instagram.) But Lisa’s doctor didn’t suggest any possibility of side effects, and when Lisa repeatedly called the office asking whether she should try to wean herself off the pills, she was dismissed.

“They were just like, ‘No, no, it’s Diclegis, it’s fine. You can take it your whole pregnancy,’” she remembers. “I tried to go off Diclegis multiple times. But with my particular relationship to nausea, I couldn’t eat. I would have insane food aversions. I wouldn’t want to touch water, and I knew that I had to take care of my body. So I stayed on Diclegis and was able to eat, but I had to deal with the side effects. And I kept thinking my whole pregnancy: I know of a product that is very effective in helping me deal with nausea — cannabis. I wish I could use it because I have experience using it without side effects, but there’s nothing out there that makes me feel comfortable to do that.”

When clinicians told Lisa that continuing Diclegis was fine, what they really meant was that it’s fine for the fetus. This overt centering of the unborn — as opposed to the birthing person — will be familiar to anyone who has been pregnant in the U.S. What’s proven safe for the baby takes credence over the well-being of the mother. And there’s not much time for discussion during appointments.

Tara’s experience was similar. The doctor told her that it was a good thing she was feeling sick, because it meant the baby was healthy. “It was like a vagina mill. It was not whole-person care,” she says. So she changed lanes and opted to have her baby with a midwife — a decision that cost her several thousand dollars out of pocket. “But it was the way that I wanted to go, and we can afford it.”

Jessica Diggs, a Los Angeles–based midwife, says the prioritizing of the fetus over the birthing person is endemic to the country’s mainstream medical care. “The unborn is just this precious entity — which they are — but often in a place that’s out of context,” says Diggs. “Western baby-centric culture is to just tell you ‘no,’ and not actually give you good parameters to make an informed decision.”

Emily Oster, the author of Expecting Better and the ParentData newsletter, has become something of a celebrity guru for science-minded parents by pushing against this culture with data analysis and human discussion. (In other words, by actually giving good parameters to make an informed decision.) She says cannabis is among her thorniest topics. While there is an overwhelming trove of peer-reviewed scientific research when it comes to pregnancy and cannabis, that data is complicated and problematic by its very nature. “When there is something that has been taboo — even if it is not illegal — it’s difficult to get good data,” says Oster. “The choice to use the substance, or to report using it, is wrapped up in other things about people.”

The data might be clouded if the women surveyed, say, also use other drugs, or drink alcohol, or, even worse for research, lie about their usage of any of the above. And, for some, even being surveyed is too much to ask. It doesn’t help that, somewhat controversially, very few drugs, even legal ones, are tested on pregnant women. Because the Drug Enforcement Administration still classifies cannabis as a Schedule I drug with no acceptable medical use, it’s difficult and expensive for researchers to carry out controlled human studies — and next to unthinkable to do so with pregnant subjects.

And so, we consult resources like Oster, who says her readers send her several weed-related queries each week. “People’s questions are incredibly specific,” she says. “Like: ‘I use this in the following way with the following kind of gummies following this and that, and what do we know about that?’ And it’s like: nothing. We know nothing.”

While we don’t know the precise effects of microdosing THC-infused pear-ginger gummies on the unborn, we do have a sense of how cannabis works in pregnant bodies and fetuses, thanks to researchers like Yasmin Hurd, a neuroscientist and the director of the Addiction Institute at Mount Sinai.

Hurd is well-known in the world of cannabis science, and her research historically has shown both good news (cbd cream can curb anxiety and drug-seeking behavior) and bad (THC’s cognitive effect on rats can be multigenerational) for weed lovers. She too hopes science can one day determine whether responsible use — through specific timing, quantities, or even strains — could be safe for pregnant women.

“These are things I think that we now need to focus on, and not to blame women,” she says. “Let’s just get information that can guide them.”

Hurd and her colleagues’ latest research comes from a decade-long monitoring of 322 mother-child pairs in New York City for an ongoing National Institute of Mental Health–funded study about stress in pregnancy.

They found that the placentas of women who used cannabis showed a difference in immune function from those who did not — namely, that the genes connected to immune response were less active than in women who abstained. (They used statistical models to adjust for confounding factors such as single parenthood, cigarette smoking, anxiety, and race.)

“That placental information told us that the in-utero environment was one of significant dysregulation of the immune system,” Hurd tells me. “The placental information helped to show that there was actually a prediction that was associated with those children who would later on go on to have anxiety disorder.”

Today’s weed is a lot stronger than whatever our bodies produce and could throw the endocannabinoid system — which is essential to delicate operations, like growing a brain — out of whack.

That result made many headlines when Hurd’s findings were published in November: “Cannabis Use in Pregnancy May Lead to a More Anxious, Aggressive Child,” wrote the New York Times.

Hurd was surprised to see how reliably those placental changes predicted future behavior. But she says we shouldn’t be terribly shocked to find that weed impacts our immune function, given what we know about how it works in our bodies — specifically in an internal network called the endocannabinoid system.

Cannabinoids are a class of chemicals that include THC and cbd cream, which are naturally occurring in cannabis plants; the endocannabinoid system is a network of receptors throughout our bodies where those molecules bind and take effect. (“Endo” means within, so consider this our internal weed system.) Because we have these natural receptors, and our bodies even produce molecules that resemble THC and cbd cream, some people shrug off the idea that adding more cannabinoids could be harmful.

“People say, ‘Oh, but cannabis is natural,’” Hurd says. “But there is no way that the THC concentrations in cannabis are the same as the natural endocannabinoids. Because it’s at these very high supraphysiological levels, it can impact these neurodevelopmental processes, which are actually very fine-tuned.”

Translation: Today’s weed is a lot stronger than whatever our bodies produce and could throw the endocannabinoid system — which is essential to delicate operations, like growing a brain — out of whack.

While it’s true that confounding factors like cigarette smoking or stress could also have impacted results, Hurd says her team has already shown that THC exposure similarly impacts animals’ placentas. (And adds that those results should be published soon.) But the good news, she says, is that these effects can likely be mitigated or even reversed by influences in a child’s home or school environment.

But in order to know which children could use those interventions, women must be able to safely discuss cannabis use with their doctors. Fear or shame, says Hurd, should have no place in the conversation.

“There shouldn’t be any stigma with it,” says Hurd. “Child services should not be called because mothers may have consumed cannabis … This is a medical issue that has a long-term impact on the medical health of their children. So this should be a medical discussion with their physicians and their care providers and their partners. Plain and simple.”

The stigma has been decades in the making. During the crack epidemic of the 1980s, a perfect storm of racism, moral panic, and bad science fueled the war on drugs and created the myth of the “crack baby.” The government, the medical community, and the press demonized pregnant drug users — particularly Black women — as depraved monsters spawning a generation of helpless, damaged children. And prosecution became a powerful tool to disenfranchise parents and perpetuate the idea that a fetus’s rights supersede that of a mother’s, a view that persists today among those who seek to police and politicize women’s bodies.

“As advances are being made in the area of legalization and destigmatization of marijuana,” says Lynn Paltrow, executive director of the National Advocates for Pregnant Women, “the place that remains highly stigmatized, and the place where I think that the war on drugs is being perpetuated, is through pregnant patients.”

Like a drug conviction, a positive drug test in the hospital can trigger a dehumanizing and damaging series of events: stigmatizing mothers as unfit parents, disrupting families through investigations, requiring classes and appearances that can encroach upon parents’ abilities to work and care for kids, and devastating parents and children alike through separation. And just like the war on drugs most severely punished people of color and those in poverty (despite the fact that they use drugs at roughly the same rates as wealthier white people), those families ensnared in the child-welfare system are disproportionately poor and Black, according to the American Bar Association.

If you are a person of color, and you even have a whiff, or you have a little tincture of cbd cream on the counter to rub onto your feet, you’re going to get a full blood panel and a social worker will come by your room.

More than one woman told me she saw state involvement as the main threat when it came to consuming while pregnant. One analysis of more than 450 prenatal visits also found that care providers were more likely to warn patients about this possible outcome than any medical risks, if they addressed the topic at all.

Jessica Diggs, the Los Angeles–based midwife and reproductive-health educator at the online platform Loom, frequently discusses cannabis with her students and patients. Although Diggs laughs at the notion that weed could manage labor pain, she takes what she described as a “gentle, neutral, harm-reduction” approach to the topic in her childbirth-prep classes, with one caveat.

“This is not applicable if you’re a person of color,” Diggs says. “If you’re a white couple, you’re walking into the hospital, you own a cannabis company, no one’s gonna bat an eye at all. You could probably leave some products for the nurses. If you are a person of color, and you even have a whiff, or you have a little tincture of cbd cream on the counter to rub onto your feet, you’re going to get a full blood panel and a social worker will come by your room.”

Shonitria Anthony, known as Blunt Blowin’ Mama to her podcast subscribers and 33,200 Instagram followers, is one of a cohort of advocate-slash-influencers working to destigmatize plant medicine and parenthood — sometimes selling ad partnerships, workshops, and products in the process. Anthony started her Instagram in 2017 after she saw a Today show piece on “marijuana moms” featuring exclusively white women. “I couldn’t be the only Black mom in the world consuming cannabis,” she tells me.

Anthony, a Los Angeles–based mother of two, is public about her own experience. Before she had babies, as a journalist in New York, Anthony smoked weed regularly to unwind. “Some folks drink wine after a long day’s work and commute on the subway,” she says. “I smoked weed.” Later, Anthony says it became something of a daily wellness aid, helping her feel focused and calm.

Cannabis made “a world of difference” when she smoked it, ate it, and rubbed it on her skin throughout her second pregnancy, as opposed to her first, which she described as “miserable.” She went on to consume throughout two years of breastfeeding her son, an extended period she proudly attributes to cannabis use.

The day we spoke, Anthony estimated she had 100 DMs on Instagram, the vast majority of which were questions about using weed during pregnancy and breastfeeding (also the topics of her most popular podcast episodes, and prerecorded workshops available for $7.99 on her website). Her followers want to know about everything from the risk of Child Protective Services to how long THC remains in breast milk after smoking.

The latter question she addressed in a podcast conversation with Evonne Smith, a cannabis-friendly lactation consultant. Smith cites research that has detected THC in breast milk six days after consumption, and at a dose of about 2.5 percent the maternal dose. (That percentage, however, comes from a survey of just eight users.)

Anthony and Smith agree — as do researchers — that the benefits of breastfeeding outweigh the risk of cannabis exposure. But they still acknowledge that we don’t know exactly how cannabinoids such as THC and cbd cream affect babies through breast milk. We do know they cross into it and are soluble in fat, so the baby is definitely getting a dose. Which is to say: It’s complicated.

“It’s not saying ‘don’t do it’ or ‘do it,’” Anthony tells me. “It’s saying, ‘Here are the best practices to reduce harm as much as possible, while you’re still able to be well.’” Those practices include practical tips like using products from known sources, carefully monitoring one’s dose, going outdoors if smoking, wearing a designated jacket to protect one’s clothes from transferring secondhand smoke to the baby, and washing hands immediately afterward.

“Most moms that I encounter, who are asking if they should consume cannabis during pregnancy, have done research,” Anthony says. “They are talking to people, they’re asking questions. Those are markers of a good mom. A good mom cares. A good mom wants research. A good mom wants answers. They’re asking questions. And I think that those women shouldn’t be vilified.” (Anthony also sells T-shirts that say, “Moms who smoke weed are not bad moms.”)

Often it’s the research itself, and media coverage thereof, that puts pot-smoking moms on the defensive. When Hurd’s latest study came out of Mount Sinai and CUNY in November — the one showing THC could disrupt a fetus’s placental environment and possibly lead to anxiety and aggression later in life — cannamoms were not having it.

“Stop demonizing maternal cannabis use,” Bianca Snyder, a.k.a. @highsocietymama, wrote on her Instagram. Both Snyder and Shonitria Anthony poke holes in studies for many of the same reasons Emily Oster does: It’s hard to untangle cannabis use from other confounding factors; studies were done before weed was legal, so products could be contaminated; we don’t know what kind of cannabis was consumed, or how, or how much.

But none of the researchers I spoke with sought to demonize or blame pregnant cannabis users, nor did anyone advocate for the involvement of the child-welfare system. On the contrary, they were looking for the same kind of clarity that cannamoms seek — and hoping to pave the way for an honest conversation between moms and doctors.

Judy Chang, an OB/GYN at the University of Pittsburgh School of Medicine whose research focuses on patient communication, has an idea of how those conversations could go. She says that doctors should offer up information about cannabis use during pregnancy as a universal counseling point rather than waiting for women to ask and risk stigmatization.

“Here’s how I phrase it: ‘I may not know for certain, but this is what I do know. And that trend makes me worried enough to be able to mention it to you and tell you why I’m concerned about your exposure,’” Chang says. “It’s still up to them to decide. And I’m not saying you’re a bad person.”

Over years of research, Chang has recorded hundreds of visits between pregnant patients and their doctors, and sees prenatal patients herself. Much of what she learned about their relationship to cannabis surprised her — that they saw weed as more of a natural remedy than a drug, and that they truly wanted more information from doctors, but didn’t feel they would get it. Also, how they consumed it.

“That’s when I had to learn what a blunt was,” Chang says. She laughs when she tells me this, but her willingness to meet patients where they are — and to discover that a blunt wrapper would also expose them to tobacco and nicotine — demonstrates what a true exchange between patients and doctors could look like.

“People seem to open up rather than shut down,” Chang tells me of her experience starting these conversations. “They may follow up with more questions or they may sort of share their own perspectives … And I’m not asking for a decision by the end of the conversation. I’m just hoping that it’s going to be a continued thing to consider and discuss.”

Chang recognizes she’s suggesting a redesign when it comes to women’s care. These kinds of conversations take real time and attention, and they treat the pregnant person as a human rather than a vessel — a recentering that sounds obvious, but is nothing short of radical.

Lisa, the pastry chef who suffered through debilitating nausea and anxiety, says she loves being a mother today. But without that sort of shift in care, a second pregnancy is hard to imagine.

“Right now, I feel like the cost would be very high — mentally, physically, and emotionally,” she tells me. “Even with the mommy amnesia, I have so much rage about how hard it was.” Maybe if there’s a second time around, she says, she would research the risks of cannabis on her own, instead of just relying on her doctor — a prospect that again fills her with rage.

“I kept thinking about that over and over again, I kept thinking: If men had to go through this, these holes in research and resources, they would not exist,” she says. “That’s something that motherhood really revealed for me on another level, was how underserved women are in their health needs.”

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