​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:
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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

​Positively PregnantYou just haven’t felt yourself lately. Your breasts are tender, you feel tired, bloated and your heart seems to be working over time.  You may even be feeling that you are coming down with something.

Wait.  ...When was my last period??

You grab a pregnancy test at the nearest pharmacy and head home in anticipation. Is this it? You wait anxiously for the 2 minutes to creep slowly by as you watch the test window like a hawk preparing an attack on it’s prey…
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You rub your eyes in shock and take a closer look…

POSITIVE!
…Well, now what?

It’s hard to know where to start! Here are some clear cut first steps to take as you prepare for your journey into pregnancy.

1. Call your Primary Care Physician.
Check in with your primary care physician to confirm your pregnancy with a blood test. When you talk to them, make sure to check about your current medications to see if you should still be taking them.

2.  To Share or Not to Share? That is the question.
And there is no right or wrong answer. It can be incredibly hard not to tell your friends and family as soon as you find out you are pregnant, but I recommend trying not to post it to social media just yet – at least not publicly. Allow yourself some time to mentally adjust to the pregnancy, the upcoming birth, and the life changes that are soon to follow.
Some decide to keep their newly developing baby a secret for fear of a miscarriage. Or, they will decide to tell only a select few close family members or friends until the first trimester is over. The pregnancy is most vulnerable during the first 12 weeks, and after the first trimester, the chance of a miscarriage drops dramatically (down to 10% of all known pregnancies). If you decide to wait for this reason, that is just fine.
And if you decide to announce your excitement to the world, that is fine too! Just make sure you do what you really feel is best for you.

3.  Call the Midwife!
Or OB/GYN. Ask friends and family for recommendations for local recommendations if you do not have a prenatal or women’s care provider. You will want to know which OBGYNs and Midwives worked best with their patients and provided satisfactory experiences to women. Google their names and see what you can find out. We can also help to match you up with a care provider that may be suited to you best.

Choosing a primary care provider is likely one of the most important decisions of your entire pregnancy and you don’t need to determine who you’d prefer to work with right this very minute. Keep in mind that you are hiring your provider to provide you a service, so at the end of the day, you are in charge.

4. Supplements
Like an apple a day, daily supplements can help give your baby the best start.

Ask your provider or general care doctor for a prescription for a prenatal multivitamin, preferably with DHA Omega -3s. Many medical insurance companies will cover prenatal vitamins in full, although fewer will cover a prenatal with DHA – the building block for the development of the brain, eyes and heart. Don’t waste your money on over the counter vitamins if you don’t have to. Check with your insurance company to see what they will cover.

Folate is a supplement essential in DNA production, repair, and function. Studies show it can help prevent neural tube defects of the spinal cord and brain – such as spina bifida or anencephaly when taken before pregnancy through the first trimester. Some research suggests that folate may help lower your baby’s risk of other defects as well, such as cleft lip, cleft palate, and certain types of heart defects.

Research supporting Vitamin D’s role in immune function, healthy cell division and bone health has been released(1). Vitamin D is necessary for the absorption and metabolism of calcium and phosphorus. Many studies are finding a connection between low serum vitamin D levels and an increased risk of certain types of cancers, autoimmune disease, neurological disease, insulin resistance, and cardiovascular disease.
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5. Research!!
There is so much to know! DON’T WAIT until you are at the end of your pregnancy to research your pregnancy and birth options, and I encourage you to read evidence-based information.

Evidence based information: 
Websites: Childbirth Connection, Evidence Based Birth, Birth Without Fear, Spinning Babies, and Mama Natural.
Books: Ina May’s Guide to Childbirth, Spiritual Midwifery, The Birth Partner, The Thinking Woman’s Guide to a Better Birth
Documentaries: The Business of Being Born I & II

Steer Clear of: 
Websites: theBump, WebMD, BabyCenter, Parents.com, What To Expect and of course, Facebook.
Books: What to Expect When You are Expecting, Your Pregnancy Week by Week, Becoming Baby Wise
TV: A Baby Story

6. Rest
Many women experience lethargy during the first weeks of pregnancy. It’s hard growing a baby; Your genetic map is being encoded and using the building blocks to create a little human and it’s nurturing placenta. So don’t apologize for allowing yourself to get some rest – you need it.

7. Seek a Doula
It’s never too early. A doula is not a medical professional but can help you navigate choices in the confusing medical world. She can share evidence-based education to help you prepare for your birth. Many times as doulas, we hear “I wish I had you to talk to from the day I found out I was pregnant! Why did I wait so long?!”

Take a look at Improving Birth’s Fact Sheet on Doulas.

Congratulations on your pregnancy!

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As if relationships weren’t complicated enough, pregnancy can throw yet another curve ball at a couple, especially when it comes to sex. It’s sensitive subject with innumerable potential discussion topics.

Some women want more sex in pregnancy, others can’t stand the thought. Even dads to be are sometimes intimidated by the thought of sex during pregnancy for all kinds of reasons. Some couples still desire sex but they wonder about the safety. Whatever you are feeling about sex is completely valid and normal, even if you think you are alone in how you feel. So here we are going to talk about the basics of sex during pregnancy. (And as always, discuss any concerns you may have with your doctor or midwife.)

Sex in pregnancy is safe. Sex is by and large completely safe during pregnancy. There are few situations where a woman should refrain from sex (we will talk about those below.) But for the majority of women, sex, including penetration and orgasm, is perfectly healthy. It even offers some tremendous health benefits in pregnancy including relaxation, lowered blood pressure, and improved sleep and increased immunity.

It’s normal if you don’t want sex. And it’s normal if you do. The way a woman’s body responds to the hormone changes that pregnancy brings is unique to each person. Some love sex, others hate it. Others are completely unchanged. And some women find that some things about sex are ok and others are temporarily off limits. All normal.

Orgasms don’t trigger early labor in a normal pregnancy. During orgasm, a woman’s body is flooded with oxytocin, which is also the hormone that causes contractions during labor. The uterus has oxytocin receptors on it and throughout the majority of pregnancy, these receptors are closed. That means that, as long as these receptors are closed, a woman can have all manner of oxytocin coursing through her body and it will not start labor. At the end of pregnancy when those receptors begin to open as a woman becomes ready to go into labor, orgasms have the potential to encourage labor to start. In these situations, sex can come in handy to help start labor – both for the oxytocin and the prostaglandins in semen.

Try different positions. The basic mechanics of sex change a bit as pregnancy progresses. The belly gets bigger and bigger making several positions harder to utilize. Furthermore, women should not be on their backs for an extended period of time after about 20 weeks. Try having the woman on top (no pressure on the belly), doggie style, or side lying. Couples can also try other means is sexual gratification including oral sex.

​You may have been hearing more about doulas in media or from friends & family, but you aren’t quite sure what the benefits of doula support are. So here are 5 clear cut reasons having a doula ROCKS!

​Doulas are not medical professionals, but they have a vast knowledge about birth and can help you navigate the confusing medical world. They will listen to your needs and help you create a tailored birth plan which reflects the birth you desire. During labor, they can help you understand suggestions given to you by staff and also think outside the box so that you can make the most informed decisions about your unique situation.

​According to a study conducted by the Cochrane Collaboration which assessed birth experiences of over 15,000 women — women who have continuous support during labor are:

• More likely to have shorter labors and give birth without vacuum or forceps
• Less likely to need a Cesarean
• Less likely to request pain medication
• And their babies are more likely to thrive and have better APGAR scores

That brings us to #4.

​Being cared for, listened to, emotionally and physically supported – it’s everything you ever wanted from your spouse, am I right? What about for you and your baby?

​Let’s face it: the end result of pregnancy and labor is having a baby. This is about the rest of your life – you will be parents forever. After the birth of your baby, there may be new challenges during the first weeks of parenthood. Doulas provide a wide spectrum of support which may include, but is not limited to breastfeeding assistance, newborn care, help around the home cooking healthy meals, laundry, and emotional and physical support.

No woman feels more judged in her life than when she is in a public place, showing her pregnancy, and holding an adult beverage.
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The horror! Passers by raising their torches and pitchforks and silently curse the mother daring to indulge in anything containing alcohol, declaring she is dooming her baby to the dreaded Fetal Alcohol Syndrome at that very moment. Doulas are asked about alcohol consumption by our clients from time to time. It’s an ongoing conversation throughout pregnancy since it’s a rather controversial topic.

Let’s examine the facts.

1. The amount of alcohol it takes to cause Fetal Alcohol Syndrome is unknown.
2. Alcohol does have the potential to affect the developing baby’s brain.
3. Each woman’s body will process alcohol at different rates, and may, therefore, affect a growing baby in unpredictable ways.
4. Nobody knows if any certain phases of development in pregnancy are more sensitive to the effects of alcohol than another.

For these reasons most providers, both midwives and OB/GYN’s, recommend not drinking at all throughout the pregnancy. Abstain completely.

However, there is one more fact that is often times overlooked or forgotten. Many women admit to drinking occasionally throughout their pregnancy without them and their babies suffer ill effects from it. (In pregnancy, “occasional” or “moderate” drinking is defined as 1-2 drinks a week). So there may be a balance; There is a safe level somewhere even if it eludes us.

Recently, a study was published about the effects of alcohol and pregnancy. Many of the findings were rather surprising.

For instance, children whose mothers had an occasional drink enjoyed better mental health than those who abstained completely. These findings certainly had other factors at play, but even when all of the controls were in place, the findings suggested the same. More research is certainly indicated, however, since experts in the field report that “correlation does not prove causation.” They continue to recommend abstaining.

So is it fair to say that moderate drinking has the potential to prove beneficial to some women? According to this study, it certainly warrants discussion. Further research is indicated in the matter of health benefits of drinking in pregnancy, along with moderate consumption.

In the end, it’s important for women to have all the facts so they can make an educated decision. While it’s true that nobody knows for sure exactly if or how much alcohol is safe in pregnancy, it’s also true that many women who indulge in an occasional drink do just fine.

Doulas are experts in gathering information and helping women to make informed decisions once they have all the facts. We would never dare to try and tell you what to do with your own body.

Check this fact sheet from the National Institute of Health. And here is some more pertinent information about risks with drinking during pregnancy.

You know yourself and your body best, and your decision to consume alcohol in pregnancy deserves to be an informed one. Know the risks – and possible benefits – for yourself and proceed accordingly.

***Edited to add: This blog post is stated as a question to referenced study & the blog itself is about gathering evidence for the informed decision. You make the informed decision for your body. I have no medical authority to make any suggestions to consume or not consume alcohol during pregnancy and this article does not suggest such. That would be beyond the scope of a doula.

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​Arguably one of the most controversial of all topics related to birth, VBAC seems to be in the spotlight again. VBAC stands for Vaginal Birth After Cesarean. In spite of overwhelming evidence that supports VBAC as the safest option for the majority of birthing women with a previous cesarean, most care providers are hesitant to support and perform them.

Women who desire a VBAC often feel like they are fighting an uphill battle just to have a normal vaginal birth. Birth doulas work hard to support and equip women to have the birth that they want. Since so few providers support it and insurance companies discourage it, women usually need to do extra careful preparation and planning as they look at their options for birth.

Care Provider – The most important thing to do when planning a VBAC is to find a supportive care provider. This may sound easier than it usually is. Many times a doctor will say they are supportive of VBAC but their stance changes once labor begins. A provider is supportive of VBAC if their statistics say so. Interview your provider carefully. Do your research. Ask to see their VBAC success rates and ask them direct questions that require more than a “yes” or “no” answer. Is their approach to birth the same as yours? Would they support alternative care, such as chiropractic care, if that is important to you? A woman can have all the support in place for a VBAC, but if her care provider is not fully on board, she will likely not have one.

Also, it is NEVER too late to change your care provider. Just because you’ve been with one for a long time doesn’t mean you need to stay with them. A more supportive provider is going to be just as qualified to be in charge of your care as the one you are struggling with. If you suspect that your provider is not on board with your desire for a VBAC, it’s ok to interview and find another one. Hiring a new provider is preferable to try to talk your current care provider into supporting your choices.Your doctor is hired by you – make sure you hire the right one.

Gestation length – Though we calculate due dates at 40 weeks, 42 weeks is clinically considered the full term, and evidence says that risks to mother and baby do not become statistically significant until then. This is no different for a woman desiring a VBAC. Waiting until the baby is ready will give the mother’s body its best chance of having a successful VBAC.

Avoid induction – The risks associated with VBAC are almost all centered around uterine rupture, which is when the uterus tears. Many times this is an emergency situation requiring an immediate cesarean, but the incidence of rupture is small – even with a VBAC. Uterine rupture can be encouraged and brought on by unnaturally strong contractions. Drugs that imitate oxytocin may cause the body to contract in unpredictable ways which can cause a rupture to occur. This is why preparing the body as much as possible for a more natural labor is so imperative.

Avoid birth interventions – Many interventions necessitate the use of artificial oxytocin to make the labor progress. Choosing one may inadvertently sabotage your VBAC. Avoid interventions, or wait as long as possible in labor to use them. The best way to avoid interventions is to hire a birth doula.

Hire a birth doula – Doulas are trained in VBAC. They can help you with everything from finding a supportive doctor or midwife to hands on support for your labor. Doulas do not have clinical skills and they do not provide medical care, but evidence shows that the presence of a doula reduces the likelihood of a woman having a cesarean – including a repeat one.

Consult with alternative care. Your birth doula can help you connect with alternative support care providers that can assist you as you prepare for birth. For example, a chiropractor can help you make sure your body and baby are optimally aligned and positioned for birth. Acupuncturists are experts in providing the body with balance so that hormones can function at their peak. Herbalists can help you make sure your body is absorbing all the proper nutrition you need. Nutritionists know what a pregnant body needs, and they can consult you to make sure you have optimal fuel for your hard working body. In each of these professions, it is imperative that you seek out a practitioner that is trained in pregnancy, and as with any treatment, always consult your care provider.

Optimal Fetal Positioning is an often overlooked essential when preparing for birth. Of course, it’s important that the baby is head down, but that is not the only important positioning factor to consider. Check out Spinning Babies to learn more about optimal fetal positioning. Birth doulas are well versed in optimal fetal positioning as well and we are available to discuss it with any client that wishes.

Consider home birth. A home birth midwife will not accept you as a client if she is not confident she can safely manage your birth. A midwife will likely incorporate all of the above-mentioned factors into your midwifery care as well. Many women safely birth vaginally at home after a previous cesarean.
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VBAC is a safe option for the majority of women. When planning for a VBAC, mothers need to be selective and deliberate. With a little extra careful planning and support, a mother can achieve the birth she desires.