Legislation has Changed But Issues Remain: Provider Perceptions of Caring for People Who Use Cannabis During Pregnancy in Safety Net Health Settings, a Qualitative Pilot Study

Abstract

Objective: To identify perceptions of cannabis use and risk among maternal health providers who provide care for people who use cannabis during pregnancy in safety-net health settings. Methods: Using qualitative, constructivist ground theory methods, we conducted semistructured remote interviews with 10 providers (2 midwives, 6 OB/GYN physicians, and 2 OB/GYN residents) in Southern California, United States, between March 15, 2022, and April 6, 2022. We selected participants through selective sampling using a convenience sample and snowball approach. Providers were eligible for the study if they self-reported via survey to being a maternal health provider ( e.g ., physician, doula, midwife, and so on) providing care in a safety-net health setting and had cared for people who used cannabis during pregnancy in the last year. Analysis drew upon grounded theory methods to document the socio-structural contexts that contribute to provider perceptions about cannabis. This study was approved by the University of Southern California Institutional Review Board (UP-21-00282-AM009). Results: We identified three categories of provider perceptions of cannabis use and risk during pregnancy: (1) Relying on self-education, (2) Taking a case-by-case approach, and (3) Avoiding cannabis discussions to maintain an alliance with patients. Findings indicate that provider reluctance to counsel patients about cannabis in favor of preserving a therapeutic relationship can overlook the lack of resources and access to health care alternatives available to low-income patients that can shape self-medicating. Conclusions: Nonpunitive policies and training on cannabis use are critical steps for supporting providers to counsel patients who use cannabis during pregnancy, alongside a harm reduction approach that acknowledges the broader socio-structural contexts and barriers facing patients who disclose use.

The unseen patient: competing priorities between patients and providers when cannabis is used in pregnancy, a qualitative study

“…ACOG states that, “[s]eeking obstetric–gynecologic care should not expose a woman to criminal or civil penalties for marijuana use,” which requires clear guidelines for how to handle cannabis disclosure during prenatal care ( 72 ). The current ambiguity in guidelines leaves room for provider stigma, knowledge gaps, and individual case-by-case evaluations of cannabis screening which works against structurally vulnerable pregnant patients ( 29 ). Patients must know that when they disclose their cannabis use, they have structural protection from medicolegal consequences.…”

“…We conducted qualitative interviews with maternal healthcare providers as well as people who use cannabis during pregnancy, an approach that has been documented in our other studies ( 29 , 33 ). The research team consisted of advanced public health students (RMN, SSG), research staff (EEG), faculty co-investigators (GFD, CVB, TMB), and a faculty member (RCC) acting as the Principal Investigator of the study.…”

“…The paucity of reliable, high-quality data on the long-term effects of maternal cannabis use coupled with conflicting stances in healthcare settings can lead to potential confusion among both patients and practitioners ( 20 , 25 , 29 ). While more data is emerging, little is understood about how individuals navigate care settings while using cannabis during pregnancy or discussing maternal cannabis usage with their providers.…”

“…Pregnant individuals who are considering using cannabis report perceptions of insufficient data as well as not seeing providers as sources of information or care on this topic (24,25). On the other hand, providers often describe a lack of confidence in their own knowledge of cannabis and the available medical protocol regarding maternal cannabis use, leading to issues with screening and counselling (5, [26][27][28][29]. ACOG and other groups recommend universal screening practices for substance use in pregnancy, but screening is often non-standardized and is fraught with racial disparities (30).…”