“No one loves my baby more than me:” A qualitative study of patients’ decision-making regarding cannabis use in pregnancy

Objectives Since the legalization of cannabis in Canada, there is growing concern about the impact of perinatal cannabis use. Existing efforts to capture patient perspectives have failed to explain why patients may choose to use cannabis in pregnancy. Thus, we sought to explore how patients make decisions about cannabis use in the perinatal and post-partum period, and to determine what experiences, factors, or information they consider to be important in the decision-making process. A clearer understanding of patients’ decision-making processes will enable more effective patient-centred conversations surrounding cannabis use. Methods In this constructivist grounded theory study, we conducted individual semi-structured interviews with 15 pregnant or recently post-partum patients across Canada. Interview questions explored the personal, social and health factors that informed their decisions around cannabis use. Data collection and analysis were iterative. Results Our participants described how their cannabis use was driven by physical and mental health challenges arising during pregnancy that negatively impacted their lives. Participants felt that cannabis improved their symptoms and thus their ability to function. Decisions around cannabis use were not made lightly; participants carefully weighed the perceived benefits of cannabis against its potential harms. Participants expressed a strong desire to protect their fetus from harm and were eager for expert guidance to support their decision-making process. Conclusions Our data illustrates the perceived benefits that pregnant patients derive from cannabis use and suggests that cessation-focused counseling is likely to fail. Rather, harm-reduction approaches may have greater promise, as they explore patients rationale for cannabis use and its perceived benefits.