Cannabis and pregnancy; consider it the final taboo. Both are difficult to study: marijuana is still a Schedule 1 drug and has been nationally illegal to use recreationally until very recently, while pregnant and nursing women are often excluded from clinical studies about safe medicine use, over fears of possible harm. Meaning, if you want to know whether any parts of the cannabis plant are safe during pregnancy, you’re not going to find any conclusive answer. In fact, the only thing we do know is that we don’t know how exactly cannabis will affect a woman and her baby.
Yet, despite the lack of long-term clinical studies involving cannabis and pregnancy, marijuana use among women who are carrying or breastfeeding is rising. In California, the number of pregnant women using cannabis almost doubled between 2009 and 2016, according to a study out of Kaiser Permanente Northern California—the only U.S. healthcare system that screens all pregnant women for prenatal marijuana use.
Kelley Bruce, the founder of CannaMommy—a non-profit virtual clinic to educate pregnant, laboring, and postpartum mothers on cannabis—turned to the substance after she was hit by a drunk driver on New Year’s Eve. She’d been living as a children’s ski instructor in Vail, Colorado; with two herniated disks and three months left in the season, Bruce had no choice but to get back on the slopes. So she accepted her doctor’s cocktail of medication: Soma, a muscle relaxer, Percocet for the pain, and Ambien to help her sleep. “I started getting nervous about how I kept needing more [drugs] to feel better,” says Bruce. “And it wasn’t until I had a really scary out of body experience—I was tending to my one-year-old daughter, but couldn’t remember doing it the next day—that I decided I needed to find other options.”
By talking to growers and open-minded doctors alike, Bruce finally found the strain, application, and higher cannabidiol (CBD) to tetrahydrocannabinol (THC) ratio that worked for each specific ailment. (CBD is a compound found in cannabis that is associated with medicinal properties like anti-inflammation and pain relief, and THC is responsible for the plant’s psychotropic effects.) And she told everyone she knew. “I became a walking billboard for medicinal marijuana,” she says. “And that’s when Child Protection Services came knocking on my door.”
Despite displaying her medicinal card, and providing proof that she was working with her doctors, Bruce was charged with endangering a minor and other crimes. “I was completely naive,” says Bruce. “I openly admitted to using a Schedule 1 drug in my home but [thought it was okay because I] never did it in front of my child.” And while most of the charges were eventually dropped after Bruce “rose hell” in the form of countless appeals, letters from the community, past employers, and her daughter’s father, she still got two years of probation. The experience is what led Bruce to start CannaMommy. “Mothers are the most vulnerable cannabis users out there right now,” she says.
Apart from its cultivation practice, CannaMommy is a free, virtual, and confidential clinic designed to help mothers navigate the confusing and expanding world surrounding cannabis and pregnancy. Run by volunteer registered nurses who field clients from California to Germany, most calls are about how to manage symptoms while not harming their babies, as well as understanding the legal ramifications after use, says Marissa Fratoni, RN, the director of wellness for CannaMommy. “One of my patients was recently admitted to the hospital due to hyperemesis gravidarum, or HG,” says Fratoni, explaining that 3% of women experience this severe type of vomiting that leads to dehydration, weight loss, hospitalization, and potential endangerment of the fetus. “She was told she needed IV fluids and a feeding tube in order to stay in her pregnancy. She tried cannabis [instead], and it helped.”
While positive anecdotal evidence is on the rise, the CDC does report that smoking cannabis during pregnancy is linked to lower birth weight in babies. And chemicals from cannabis, particularly THC, can be passed to a baby through a mother’s breast milk. That said, data on the effects of cannabis exposure to the infant through breastfeeding are conflicting. But to limit potential risk to the infant, the CDC recommends breastfeeding mothers reduce or avoid marijuana use altogether.
Cambria Benson, the founder of Serra, a “modern druggist” in Portland, Oregon, modified her cannabis use during pregnancy. “Given there is no definitive answer or information when it comes to the safety of cannabis and pregnancy, I only use CBD to deal with extreme nausea or sleep deprivation,” she says, nine months pregnant with her second baby at the time of this interview. “That said, we have plenty of pregnant women who shop [a range of products] at Serra. We don’t judge, because it’s such a personal choice.”
Dr. Janice Knox, MD, MBA, a retired anesthesiologist who now runs a cannabinoid-focused medical practice in Portland with her husband and two daughters, also doctors, believes there is a future in which a low dose of CBD could be seen as a multivitamin, but she still wouldn’t give a blanket okay to using cannabis during pregnancy. “The conversation between the embryo and the mother’s uterus is just too complicated, and there is not enough research to prove efficacy in vivo,” she says, recalling studies that have shown developmental toxicity such as increased embryo-fetal mortality in pregnant rats while under the influence of Epidiolex, the only FDA-approved CBD medication, which has been found to help treat seizures. Knox does believe, however, that one of the best things you can do before a major operation like birth is to mitigate stress.
“It’s the Sphincter Law,” says midwife Laura Erickson, LDEM, CPM, director and owner of Alma Midwifery in Portland, Oregon, recalling the work of renowned midwife Ina May Gaskin (author of such go-to pregnancy books like Spiritual Midwifery and Ina May’s Guide to Childbirth). “In order to give birth, you have to be able to relax.”
Perhaps that’s why there is a sudden movement around CBD and birth, suggests Benson, recalling Serra shoppers who have used cannabis oil vaginally, topically, or orally during delivery. Dr. Andrew Kerklaan, DC, the president and founder of Dr. Kerklaan Therapeutics, a range of hemp-derived, CBD-based topical products out of Canada, agrees there may be a place for cannabis leading up to and during the recovery period after birth. He is currently working on a CBD-based topical that won’t enter the bloodstream, therefore not exposing the baby to the substance. Bruce, ever the pioneer, is getting ready to put out CannaMommy’s first-ever topical made for delivery. Part CBD, THC, olive oil, and vitamin E and D, it’s meant to reduce inflammation, prevent tearing, and help the cervix stretch when applied as the baby’s head starts to crown. “I didn’t even feel the ‘ring of fire’ during my last child’s birth,” says the mother of four. Talk about a positive trip.
by KATE BRANCH