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

Rachel Carmen Ceasar; Erin Gould; Julia Stal; Jen Laughter; Michelle Tran; Shirlene D Wang; Jordan Granacki; Ryan S Ziltzer; Jasmeen Joy Santos

doi:10.1089/whr.2023.0057

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

Womens Health Rep (New Rochelle). 2023 Jul 28;4(1):400-408. doi: 10.1089/whr.2023.0057. eCollection 2023.

Authors

Rachel Carmen Ceasar¹, Erin Gould¹, Julia Stal¹, Jen Laughter², Michelle Tran¹, Shirlene D Wang¹, Jordan Granacki¹, Ryan S Ziltzer¹, Jasmeen Joy Santos¹

Affiliations

¹ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
² Department of Sociology, California State University, Fullerton, Fullerton, California, USA.

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.

Keywords: cannabis; health care provider knowledge; maternal health; pregnancy; prenatal cannabis use; substance use.