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

• Published in: Women's health reports (New Rochelle, N.Y.) N.Y.), 2023-07, Vol.4 (1), p.400-408
• Main Authors: Ceasar, Rachel Carmen, Gould, Erin, Stal, Julia, Laughter, Jen, Tran, Michelle, Wang, Shirlene D, Granacki, Jordan, Ziltzer, Ryan S, Santos, Jasmeen Joy
• Format: Article
• Language: English
• Subjects: cannabis; health care provider knowledge; maternal health; Original; pregnancy; prenatal cannabis use; substance use
• ISSN: 2688-4844; 2688-4844
• DOI: 10.1089/whr.2023.0057

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. 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 survey to being a maternal health provider ( ., 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). 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. 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.