​Marijuana Use In Pregnancy


One of the more controversial topics of discussion in the birth and parenting community of late has been the use of marijuana and marijuana-based substances during pregnancy. With the legalization of recreational use in Massachusetts on the dawn, discussions abound with big opinions on both sides of the highly polarizing argument.


Women want to know:

• Is it a safe alternative to many of the drugs prescribed for various pregnancy ailments?
• Can it be used during breastfeeding?
• What are the risks?
• And since it’s legal, can I use it without repercussions from the medical community?

Since marijuana is now legal in many states, many people assume that it is therefore considered safe. Women who have decided to use marijuana during pregnancy have reported that it is an effective remedy for everything from morning sickness to back pain. The internet is filling more and more all the time with anecdotal reports from parents claiming that they used marijuana during pregnancy and turned out to have a healthy child.


But unfortunately, anecdotal reports simply do not give us enough conclusive information to say for certain that it is safe for use during pregnancy. More research is needed. Yet researching marijuana use in pregnancy is more difficult than it sounds.


It is unethical to knowingly expose a patient, including a fetus, to a substance that may have unknown risks. Due to the ethical complications of such a study, it may not be done – at least not any time soon. The only way to compile research would be to follow women who admit to marijuana use during their pregnancies and document their outcomes.


But here again, this presents a few problems.


There are still many in the medical field who will report a woman to CPS (Child Protective Services) if they admit to using marijuana while pregnant. Women are understandably scared to share this information with their providers, so we really don’t know how prevalent it is or if there were any side effects from their use.


It gets even more complicated when we start trying to decide if marijuana based substances are safe as well, including CBD products that do not contain the psychoactive THC component. Is CBD safe in pregnancy?


We really don’t know.


Pharmaceuticals that are prescribed during pregnancy have well known and documented risks and benefits, giving doctors a confidence about prescribing them. Pharmaceuticals are somewhat predictable. Doctors are more comfortable prescribing a drug whose risks are known and documented that they are with “allowing” a woman to use marijuana, whose risks are still widely unknown.


So, is it safe?


Well, the jury is out, simply because there is not enough evidence about marijuana use in pregnancy. It’s starting to come out more and more that pregnant women have been using marijuana safely for many years. That’s not to say it is unsafe – but it’s not to say it’s not either! It just means we need more data to draw any sort of evidence-based conclusions.


What about breastfeeding? Here again, we must wait for data to say for sure. We do know that THC, the psychoactive component of marijuana, has been found in the breast milk of mothers who were using marijuana while breastfeeding. What sort of effect does that have on the nursing baby? We really cannot be sure.


As a doula, I tend to work with a population that values a more natural lifestyle. Some parents argue that marijuana is a plant, and therefore it’s safe for consumption and use. But please know that just because it’s a plant doesn’t mean it’s risk-free, and particularly during pregnancy, caution is prudent.


So for now, it’s up to you to make the decisions best for you or to hold off completely. Until there is more research showing that it is a safe alternative, it is considered best practice to avoid it during pregnancy.


For additional information, please check out the following:
​
Professional Survey of Medical Use of Marijuana https://www.scribd.com/document/241019203/Medicinal-Use-of-Cannabis-Aviva-Tracy-Romm
Cristen Pascucci of Birth Monopoly and  Birth Allowed Radio interviews Heather S. Thompson PhD Marijuana and Pregnancy: http://birthmonopoly.com/ep-15/
CDC Centers for Disease Control: https://www.cdc.gov/marijuana/factsheets/pregnancy.htm
ACOG American College of Obstetrics and Gynecology: https://www.acog.org/Patients/FAQs/Marijuana-and-Pregnancy?IsMobileSet=false

​​There is not a single parent that, during a pregnancy, plans on having to deal with preterm labor. While it’s true that pregnant women should not obsess about it to the point of worry, all pregnant women should be aware of the signs to watch for. So for the sake of gathering information, we are going to discuss the basics of preterm labor in this post.

​Clinically, a pregnant woman is considered to be full term at 37 weeks. It’s important to note, however, that clinical definitions do not reflect the actual readiness for life outside the womb for every baby. When allowed to gestate until they are ready, most babies will go to 40 weeks and beyond, and waiting until they are ready is safest for baby. But sometimes babies will come on their own from 37 weeks on, and those who do tend to need very little medical attention. Because the definition of a term pregnancy is considered 37 weeks, a labor that starts anytime before 37 weeks is called “preterm.” Any kind of labor is defined by contractions that cause the cervix to change. Many women experience contractions before they reach 37 weeks, but if they do not cause the cervix to change, it is not considered to technically be preterm labor.

​In short, nobody knows. There are a number of things that can contribute to a woman’s preterm labor, but each situation is different. For the most part, modern medicine does not fully understand all the mechanisms contributing to preterm labor. Because they do not understand it, they do not have all the appropriate the tools to treat it.

​The signs to watch for in preterm labor are the exact signs of regular labor. The only difference is that they take place before 37 weeks gestation. Do not hesitate to go to the hospital if you think you suspect preterm labor. The earlier it is caught and diagnosed, the easier it is to manage and stop. There are many signs of labor, but the primary sign to watch for is contractions that are getting stronger, longer, and closer together. In any kind of labor, you may feel a bit nauseated, lose the mucous plug, and your bowels may empty. If your water breaks, you are definitely in preterm labor and you should go to the hospital right away.

​When you arrive at the hospital in preterm labor, you will first be sent to triage for assessment and monitoring. This is the same as if you were having a full term labor. The triage nurse will notify your care provider (doctor or midwife) of the situation. Your care provider will then give care orders to the nursing staff and they usually manage the majority of your care.
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Depending on the intensity of your contractions, the staff may choose to simply monitor you and your baby to see if labor progresses. They will be watching for the cervical change. If labor does not progress and it appears that you are only experiencing minor contractions, you will likely be sent home with instructions to rest and hydrate. However, if your cervix is changing with your contractions, you will probably be given a medication to manage the situation, depending on the severity.

​If you are diagnosed with preterm labor, the hospital will want to act quickly to attempt to stop your labor and there are a variety of medications they may want to use.

If they need to slow your contractions, they may choose to give you a classification of medication called a tocolytic. This is a medication that causes muscles to relax. Since the uterus is a muscle, it often times responds to this medication. This classification of medicine usually lasts several hours, so your nurse will monitor you until the effects wear off. They will want to see if labor starts up again on its own without medicine. For many women, a single tocolytic shot is all that is needed to stop a preterm labor.

However, if labor picks up again after the shot has been given, labor is indeed starting and there is not much they can do to stop it. Depending on how far along you are in your pregnancy, they may decide to give you another dose of tocolytic. If they opt to do this, they are trying to buy you as much time as possible. (The long term use of tocolytics is generally not recommended, except in very early pregnancies where the birth would be extremely dangerous.) If your pregnancy is further along and the first tocolytic dose does not work, your provider will likely allow labor to continue to progress on its own, and they will manage it like a regular labor.

In some cases, a mother can be given a steroid shot which will encourage the baby’s lungs to develop faster. After giving the shot, they will wait as long as possible to get the baby out; sometimes they will wait days, sometimes weeks, depending on the situation.

If your waters are broken and your provider wants to give the baby as much time as possible to develop in utero, sometimes they will give you antibiotics to prevent infections from developing. As long as there is no infection, chances are baby can still stay in utero and develop a while longer.
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Modern medical advances have been lifesaving for many babies and mothers experiencing preterm labor. Many preterm labors can be safely managed, and fortunately many very early babies can be saved. It is never optimal to have a baby before they indicate that they reach full development, but most of the time it is manageable. The most beneficial thing that moms can do during pregnancy is to take good care of themselves and their health to the best of their abilities. Then, love on those babies whenever they arrive.