April Pride: This podcast discusses cannabis, and is intended for audiences 21 and over. Today, on How to Do the Pot, the question I get asked in quiet hallways, at conferences, women’s bathrooms, whispered, by text, a question so contentious to answer that only a very few people even respond to my requests for interviews. Can I use cannabis if I’m pregnant?

April Pride: As women are put under constant scrutiny from the time we’re small, what we eat, what we wear, how we wear our hair and makeup, or don’t. For all the judgment women endure as individuals, motherhood intensifies everything. At the peak moment, when the world is watching you, and you’re watching yourself, so often it’s when we’re pregnant. Maybe you tried and wanted this baby for so long. Maybe you didn’t expect to be pregnant, but you’re having a baby. Either way, you’ve got so many hormones and a changing body, anxiety, stress. These are all big reasons people use cannabis. What about this often extremely stressful time? Is cannabis safe? Is it absolutely dangerous?

April Pride: Today we explore the data around how many women use cannabis while pregnant and the potential effects. What doctors see in their practices for women who do do the pot while pregnant or breastfeeding, what we know about using THC or CBD. And given how many people use cannabis to treat everything ranging from nausea to anxiety, why this is a subject we should consider seriously for women’s physical and mental health.

April Pride: I’m April Pride. I do the pot, and I talked to a lot of women who also consume cannabis. So there have been a lot of headlines about cannabis use during pregnancy or nursing. A study conducted by Kaiser Permanente of their patients and the women who are coming in pregnant, the younger these patients are, the more likely it is that they have been consuming cannabis during their pregnancy and will most likely continue postpartum.

April Pride: We are offering this episode on pregnancy not because we’re making a stand in terms of we condone consuming during pregnancy or we think it’s blasphemy, right? This is an issue impacting women’s lives, unborn children’s lives that we cannot ignore.

April Pride: There is so much interest in what really happens when women use cannabis while they’re pregnant or later while adjusting to the chaos of life with a newborn. In my experience, marketing, and I hate to use that word, but marketing cannabis to women over the last four years, this topic, pregnancy, is the only topic that has two times the engagement of the next highest topic across every form of communication, whether we’re talking about on social media and newsletters, the DM’s that I get, twice as much every time. But just like patients are scared to tell their doctors that they use cannabis, so many doctors, even doctors who work with cannabis were scared of talking about this with us, but we don’t give up easily here at How to Do the Pot.

Dr Melanie Bone: My name is Dr. Melanie Bone and I am a OB GYN by training. I currently am on sabbatical from my GYN practice for one year in which I’m exclusively practicing cannabis medicine, which I’ve been doing in conjunction with my GYN for the last four years. And I decided to devote myself entirely to cannabis for this year, and then make a decision about what I want to do after the year is up.

April Pride: Dr. Bone comes to cannabis medicine with over 25 years of experience as an OB GYN. What does the research tell us about cannabis use during pregnancy?

Dr Melanie Bone: So of course, in our country we suffer from the fact that THC is a schedule one and therefore we can’t study it. So most of our studies are either studies that have looked at women outside of the United States, which may or may not really relate to what happens in the United States. But in the United States, the only, and I’d love to put ellipses around this, studies we have, our observational data done from asking pregnant women what they do and don’t do during pregnancy.

Dr Melanie Bone: And this is a difficult thing to do because so many women will not tell you the truth. They’re afraid, they’re afraid someone will come after them. I’ve had women who were cannabis users during pregnancy who said, “Well, they’ll put me in jail. They’ll take my baby away from me.” And so most women who use will lie, and they will never give you an honest answer because they’re fearful of the repercussions. So a lot of cannabis use in pregnancy is secretive, and that precludes us from getting good data to really determine what, if any, real effect there is on the mother, the developing fetus and beyond.

April Pride: I want to tease out two important things Dr. Bone just said, that we don’t know the real effects and that women are scared to be honest. People conceal all kinds of behavior from doctors, whether or not they’re pregnant. They may be drinking, they may be smoking tobacco. All of these behaviors, fairly normal for women who are not pregnant are extremely frowned upon, and yet not uncommon.

Dr Melanie Bone: There’s only one approach. The approach is do nothing, take nothing, and we won’t even consider anything besides complete abstinence. But if you look at human nature, abstinence is a very difficult place to go for many women, many men.

April Pride: So, are doctors accounting for the reality of human nature when advising pregnant women? The party line is…

Dr Melanie Bone: No amount of alcohol, not one drink, and no amount of substance, not one puff or hit of a joint is acceptable while you’re pregnant.

April Pride: The FDA has also released its guidance, basically just say no. To THC and CBD during pregnancy and while breastfeeding. And yet as you heard Dr. Bone say a minute ago, that’s not very realistic, but the fear of what can happen if you are honest, is very real.

Dr Melanie Bone: There was a time when if your patients use certain substances you needed to report it. And I’ve seen patients incarcerated during their pregnancy to prevent them from using something that would hurt a baby. And this is generally referring to people who are using intravenous drugs, but I think that fear really plays a huge role in what people are willing to reveal about themselves. So I’ve got to believe that at least one in 10 women are using some amount of cannabis during their pregnancy. I can’t hang my hat on it and show you a definitive piece of information, but I would say probably that’s not an inaccurate number.

April Pride: So the studies are limited. Self-reporting is flawed. You just heard Dr. Bone say that 10% of women are using cannabis while pregnant. What do we know about what can actually happen?

Dr Melanie Bone: Cannabis may cause you to have premature labor, mild increased risk in stillbirth, possible longterm neurologic damage to your child, I think is how they word it. Something along those lines. And low birth weight.

April Pride: Again, that’s the party line from traditional medical boards. Before we get back to the maybe one in 10 women who use cannabis during pregnancy, I want to acknowledge how all of this official guidance and advice lands with many women.

Dr Melanie Bone: When people discover they’re pregnant, the first instinct in our country is to make your body your temple and to not allow anything that would in any way harm your body to enter it. So therefore you’ll notice women start doing things like they won’t drink coffee at all anymore. This is one of my pet peeves as a doctor because a cup of coffee has never been shown to be harmful to a pregnant woman, but they all want to give up coffee, they say caffeine is terrible. And I just don’t happen to believe that. Anything in moderation is probably okay.

Dr Melanie Bone: And I think as doctors, we have a tendency to believe that patients don’t have the wherewithal to look at those three parts to the decision, risk, benefit, quality of life, and come up with their own answer. But we should. Everybody, you get to decide what you’re going to eat. We might say to you, “Oh, if you eat sushi when you’re pregnant and it’s not good fish, you could get sick.” But then again, I tell people, “If you’re not pregnant and you eat bad sushi, you might get sick.” So do you value your body differently when you’re pregnant than when you’re not pregnant? I don’t think you should. You should value yourself, always.

April Pride: Valuing yourself, for some people, can mean valuing the benefits of cannabis and enduring the extreme physical and emotional stress of pregnancy, childbirth and postpartum.

Dr Melanie Bone: If for some reason I find out that using cannabinoids might do something, and it’s not major, it may be minor, it might be ADHD, it might be a learning disability, but it might really be nothing at all and we just haven’t found that out yet, how do you handle it? That’s a risk, but what’s the benefit? The benefit is you feel better on it and you might not be emotionally stable if you don’t use it. And we’re not talking about people who just want to use cannabis for fun while they’re pregnant. I think one of the things you might do when you’re pregnant is say, “Well, getting high just for fun, that might be a sacrifice I’m willing to make a not do while I’m pregnant for the sake of the unborn child,” since we don’t have the data. But if you use cannabis as your medicine, it’s another story. It’s what keeps you emotionally stable so you can care for yourself and your future child. And then there’s the quality of life. So we have the risk, the benefit, and the quality of life.

April Pride: In addition to the choices women who use cannabis or caffeine or SSRI’s make during pregnancy, there are new and different challenges after a child is born, a time when hormones change dramatically again, and an unpredictable bundle of joy and terror constantly looms. You may find yourself blue. What have you seen in terms of the benefits postpartum for women after they have a child and they choose to consume cannabis?

Dr Melanie Bone: That’s a great question. So nowadays we become very aware of postpartum depression and mood disorders that are related to women specifically in the postpartum period. And I definitely have seen moms who elect to stop breastfeeding because they have found that cannabis treats their mood disorder better than anything, and yet they are afraid of what they might do to their child, and they make that difficult decision because they realize that the mood disorder is in some ways almost more important, because if they’re depressed, then they might hurt themselves or their baby, it doesn’t matter that they protected their baby from cannabis. It’s much better that they treat their mood disorder.

Dr Melanie Bone: And I know we stress breastfeeding as best, but I always tell people, I don’t believe in guilting someone into doing it. And you can’t tell walking down the street who’s been breastfed and who was bottle fed, and there was a period of time, I think in the ’50s, and maybe even somewhat in the ’60s when we thought you got better nutrition with formula, and women were encouraged not to breastfeed. And I don’t see that we have a generation of people who were so harmed. It is more natural to breastfeed and it’s nice, but if it’s breastfeeding versus your mental health, I think you would probably want to get your mental health in order first.

April Pride: So let’s just say you’re pregnant and you need to get your mental health in order, or you’re experiencing nausea and insomnia. The University of Washington is studying whether cannabis may be less harmful than traditional anti-nausea drugs, but we don’t have the results of that study yet. What do you do? You typically use cannabis as medicine and it really helps.

April Pride: For today’s high five, hot topics related to cannabis, pregnancy, and postpartum. Number one, breastfeeding.

Dr Melanie Bone: About 10% of what you take in as cannabinoids will cross the breast milk on average is what’s proposed. So they say, “Well, if I only do this much and then I breastfeed, I’m minimizing the exposure.” But it’s a difficult situation to face as a young mother because you’re dealing with the exhaustion of trying to care for a newborn and the stresses of a newborn, and at the same time trying to manage your own mood disorder. It’s very difficult.

April Pride: Number two, topicals, are CBD creams and patches in a totally different bucket than smoking or vaping? Dr. Bone says not really.

Dr Melanie Bone: Topicals are interesting because the molecules are fairly large and people wonder how can they cross the skin and become absorbed. But they do. And I don’t know that we always understand the mechanism of action of that absorption, but I will tell you as a cannabis practitioner, I have patients that use THC patches for example, and they definitely feel it. So, we often think of the skin as a barrier, but at the same time the skin is the largest organ in the body and it does absorb a lot, and therefore to say, “Well, I’m just using a topical because I’m not ingesting it, and it’s not going through my liver as the first go, or through my lungs. It should be safe.” I think that you can’t make that assumption.

April Pride: Number three, CBD. We don’t have better data about CBD or CBD paired with a low amount of THC. Though anecdotally…

Dr Melanie Bone: I see patients are happiest, not with the highest THC products, they actually do better with lower THC products.

April Pride: Number four, people sometimes ask about CBD from hemp versus CBD derived from a cannabis plant. Basically get the best quality stuff you can. Just remember, CBD products at dispensaries are regulated, which means you’re going to get tested goods and you’ll get what you think you’re paying for.

Dr Melanie Bone: If you don’t know the provenance of where your CBD was grown and processed, and you don’t have an opportunity to look at that certificate of analysis or understand it well enough, then you’re much better off getting your CBD from a dispensary than from your local green market.

April Pride: Number five, a weed hack about postpartum sex. So there’s a lot of controversy around the topic of cannabis and pregnancy. There’s not a lot of controversy or conflict of feelings around postpartum sex. It is scary to think about putting something in where a child just came out of your body. There is not a simpler way to put it. Here at How to Do the Pot, we want to help ease that transition, whenever you’re ready for it. Quim, a women-led company in California has just released an amazing product, perfect for postpartum sex called smooth operator, and it ships nationwide. It’s hemp derived CBD, and it’s aloe based. Why should you care about that? Because aloe and latex can work together. It’s a latex friendly serum and lubricant, and all Quim products fight the cycle of vaginal dryness.

April Pride: Using a lubricant which often contains glycerin, I know I have plenty of friends, it leads to UTI’s, and then they end up on antibiotics and then they get yeast infection. Rinse and repeat. Thanks to Quim, you no longer have to worry about that cycle on top of sore nipples and sticking a you know what in a you know where. I’m going to ask you guys just to bear with me because I just can’t wait to say this. Buy this now and prepare for a pleasurable reentry to intimacy. This can be fun. You have to prepare for it in advance though in order to enjoy it. Visit itsquim.com, itsquim.com to purchase smooth operator. That’s itsquim.com and you enter promo code, do the pot, for 10% off at checkout.

April Pride: As you’ve heard, we know some things about pregnancy, postpartum and cannabis. It’s a challenging and stressful time. Judgment is everywhere and there are so many voices in our ears. For people who need cannabis as medicine for pain relief, nausea, anxiety, or other extreme conditions, choosing between your wellbeing and potential risk to a child can be an excruciating decision.

April Pride: The shame, what if I screw my kid up? What if it has something to do with the decision that I made? We’re getting more comfortable speaking openly about the times as women and moms that we fall short of perfection. This episode is for you, the women who have been asking me, “What if I did? What do I do?” I don’t have an answer, but I do want you to know that you are not alone. Again, this is a topic that I get twice as many DM’s, twice as many pulled aside into the corner at conferences and at cocktail parties. I hear so much, and I feel like it’s only fair to share a little bit about my own story around cannabis and pregnancy. Full disclosure, I don’t have an experience with pregnancy and cannabis. I did not consume cannabis while I was pregnant with my two sons, but I did drink too much after my first son was born. Arguably it was not any more than I had been drinking before he was born, but I did try to continue the same lifestyle and it didn’t work.

April Pride: After the birth of my second son, I was completely sober for three years, and in 2014, four years after he was born, cannabis became legal in Washington State, and I was very grateful to be California sober and to choose cannabis even if I wasn’t drinking, and I can’t believe that that wasn’t an option for me or that I didn’t feel like that was an option after the birth of my first son. I think it would have been a very different experience, not just for me, but obviously for my child and for my husband. So I want other women, the motivation here is for other women to have more choices between doing nothing or drinking, because it’s totally acceptable and normal to have a bottle of wine at a play date.

April Pride: We’ve talked a lot today about shame and judgment that pregnant women endure. We’re not here to judge, but rather present the data and information that we have today, and of course we will continue to update you as we have more information, as more research is conducted. The information that we presented today is not enough to help you decide conclusively what your next step should be, if you’re determining whether or not cannabis has a place during your pregnancy or after your pregnancy. But we hope that we’ve given you enough information to understand a little bit more about harm reduction, and how to make the right decision for yourself and your family.

April Pride: Thanks everyone for listening today. If you liked the episode, please share it with someone and please rate and review us on Apple podcasts. It helps more people find the show. Thanks also to my co-founder Ellen Scanlon, our marketing manager Alli Musolino, producer Gina Delvac, and Steven Hoffman and Ben Adair at Western Sound. I’m April Pride, and we’ll be back soon with more How to Do the Pot.