Stumble upon any number of online communities for pregnant women and you can't help but find women, mostly in their first trimester, spilling their guts (figuratively) about the fact that they're spilling their guts regularly and feel as if they want to die daily from the nausea, inability to keep down food or drinks and the constant vomiting.
According to the Mayo Clinic's Mary Murry, anywhere between 50 to 90 percent of pregnant women experience some nausea - to varying degrees. For most women, the nausea peaks, says Murry, around nine weeks and ends by about the 18th or 19th week of pregnancy. For five percent of unlucky women, however, it persists until the bitter end. It's hardly surprising. If you've been pregnant or know someone who has, it's likely that the saccharine sweet euphemism "morning sickness" doesn't do justice to what you or your friends have felt. For some pregnant women, the nausea passes quickly and easily. For others it becomes a daily - or even hourly - battle between ones' body and ones' intellectual understanding that if one doesn't consume a crumb of food at some point one will slowly starve or starve ones' poor, growing embryo or fetus. This condition is called hyperemesis gravidarum and the constant vomiting and nausea lead to extreme weight loss and even malnutrition for the woman. It's dangerous.
If there's one theorem I can prove, however, it's this: for every pregnant woman in the world who's experienced any symptom or discomfort under the sun, there are a million different suggestions for treatment. But what happens when one of those suggestions is the use of an illegal substance?
When it comes to nausea and vomiting, women experiment to be sure: from prescription medication to concoctions of ginger tea and herbs to acupressure wristbands and more. When you're experiencing what one pregnant woman posting on the Mayo Clinic's pregnancy blog experienced, you're willing to try almost anything.
I'm 13 weeks into this and haven't had a day of peace in over 7 weeks (it was 7 weeks this past Thursday, yes, I'm keeping count). I've been nauseated and throwing up to the point of going in for weekly IVs for 5 weeks now. I couldn't wait to get pregnant and now that I am, I'm miserable and wonder how some women manage to have baby after baby! My poor husband has already succumbed to the idea that this might truly be our only child. My family and friends miss the old me; I miss the old me! The doctors and nurses keep telling me this stage will end soon, but these days seem never-ending. I wake up and dry-heave, I eat and throw it up, then I dry-heave some more and the cycle continues through my work day, and all the way until I get to bed.
Just what does "anything" look like though?
For many women, it looks suspiciously like pot. Marijuana. Cannabis. Because it is.
As one woman commented on the web site Momlogic.com, on a blog post about pregnancy,
During my first pregnancy, I was hospitalized repeatedly for dehydration due to severe hyperemesis," wrote Holly. "Zofran didn't work. I was so sick that I told my husband it was a good thing we didn't own a gun -- and at that point, I wasn't kidding .... Did I eventually break down and try marijuana? You bet. Did it work? Yes. Do I feel guilty about it? Not a single bit.
The drug to which she refers, Zofran, is a prescription drug recommended by some OB-GYNs and midwives to treat nausea in pregnant women. It was originally created for use by chemotherapy patients who suffer from extreme nausea and vomiting especially evident in the aforementioned hyperemesis gravidarum condition. It's true that Zofran works for some women; and, like with Holly, not at all for others. Some women question the safety of the medication, as well. Phenergan is another prescription medication to treat nausea and vomiting. These medications, however, are far from fail safe. Many women find themselves continuing to battle extreme deyhydration and malnutrition and are desperate for relief - even if that relief comes in the form of an illegal drug. Erin Hildebrandt chronicled her experience with life-threatening vomiting and nausea in her five pregnancies in Mothering magazine and the remedy which finally "saved her,"
"...as the nausea and vomiting increased, I began to lose weight. I was diagnosed as having hyperemesis gravidarum, a severe and constant form of morning sickness. I started researching the condition, desperately searching for a solution. I tried wristbands, herbs, yoga, pharmaceuticals, meditation—everything I could think of. Ultimately, after losing 20 pounds in middle pregnancy, and being hospitalized repeatedly for dehydration and migraines, I developed preeclampsia and was told an emergency cesarean was necessary...
"In my second pregnancy...Ten weeks after my first dose [of marijuana[, I had gained 17 pounds over my pre-pregnant weight. I gave beautiful and joyous birth to a 9 pound, 2 ounce baby boy in the bed in which he’d been conceived. I know that using marijuana saved us both from many of the terrible dangers associated with malnutrition in pregnancy."
Marijuana is the most widely used illicit drug by women of childbearing age in the United States, and it deserves more than a "talk to the hand" from health care providers, legal experts and advocates. It warrants what Lynn Paltrow of the National Advocates for Pregnant Women (NAPW) calls an "actual adult conversation" about the way pregnant women use marijuana for medicinal purposes - and the political and legal systems' move to prosecute pregnant women who may have used marijuana to quell nausea or treat extreme medical conditions.
The use of marijuana - or cannabis - to treat medical conditions is nothing new. Cannabis has been used for thousands of years for medicinal, spiritual and recreational purposes. In 2008, cannabis was found stashed in the tomb of a Chinese shaman from 2700 years ago. Experts hypothesized that it may have been used for medicinal purposes - possibly for pain relief.
Cannabis has also been used throughout ancient history to specifically treat women's reproductive health conditions - from menstrual cramps to the pain of childbirth. In the book Women and Cannabis: Women, Science and Sociology by Drs. Ethan Russo and Melanie Dreher the authors write:
"Cannabis has an ancient tradition of usage as a medicine in obstetrics and gyecology...but will surprise most by its depth of usage." The authors cite, as one example, the Ancient Egyptian mixture of hemp seeds with agents found in beer, to ease the pain of a "difficult chilbirth."
In this day and age, however, marijuana carries with it a heavy reputation. It is, of course, illegal. After more than a century of state and legislative attention to the drug, including a governmental propaganda campaign in the early part of the twentieth century ("Reefer Madness" anyone?), marijuana is placed on par with all other illegal drugs including crack, cocaine and heroine. In the 1980s, thanks to then-President Ronald Reagan, unprecedented criminal penalties for possession and dealing of marijuana were instituted and the "three srtrikes you're out" policy has given rise to an exponential increase in the number of Americans who have been arrested for possession of marijuana. Since then, however, a growing medical marijuana movement has emerged, successfully passing laws which legalize the use of marijuana for medicinal purposes, to varying degrees, in 15 states so far.
We've arrived at point in time where the intersection of strident - and extremely ineffective - drug policy has combined forces, however informally, with an equally strident anti-choice movement which has slowly helped to pass laws which criminalize pregnant women's behavior based on ideology and flimsy medical evidence. In Texas, the "Prenatal Protection Act" considers an embryo or fetus an "unborn child from conception to birth" for the purposes of murder or aggravated assault against a pregnant woman. It means an attacker can be considered for two crimes: one against the pregnant woman and one against her embryo or fetus. But pair that with drug laws like Texas' "Delivery of a Controlled Substance to a Minor," for example, and you have the perfect marriage of propaganda and control.
Alma Baker delivered twins in 2004 and tested positive for marijuana. She admitted that she smoked marijuana to treat nausea and increase her appetite during her pregnancy. Despite the fact that her children were healthy and developmentally advanced, the Texas D.A. in the county in which Baker lived brought charges against her based on both laws. Baker was placed on probation and fined. Her lawyer had this to say of Baker's felony prosecution:
“This is an end around Roe v. Wade,” he says, “and not a subtle one. By extension, where will we go with this? How about charging obese women or women who smoke with Child Endangerment?"
But, notes Lynn Paltrow, executive director for the National Assocation for Pregnant Women, the more urgent matter may be that these sorts of laws actually discourage pregnant women from seeking care. Alma Baker was clear:
“If I would have known that I’d get in trouble for telling my doctor the truth I would have either lied or not gone to the doctor,” she says.
Most major medical groups including the American College of Obstetricians and Gynecologists, the American Medical Association - and an increasing number of experts - agree with Paltrow. Paltrow's work over many years, providing extensive, evidence based legal arguments against the prosecution of pregnant women for drug use, is consistently solidified by medical expert evidence and testimony on the effects of prosecuting pregnant women for prenatal marijuana use. But what about medical evidence on the actual, physiological effects of prenatal marijuana exposure on babies?
That's the problem. There isn't much of it.
The medical evidence is sparse given testing and trials involving pregnant women and illegal drug use are not exactly easy to undertake. So organizations and providers obviously tend towards relying on a more consersative framework when discussing which drugs and medications pregnant women can safely use. They also rely on information which seems to lump together women who abuse drugs, with women who may be using marijuana for truly medicinal purposes. Even the March of Dimes web site cannot help but use the limited research on prenatal exposure to marijuana to craft a rather vague informational section on marijuana use during pregnancy:
Some studies suggest that use of marijuana during pregnancy may slow fetal growth and slightly decrease the length of pregnancy (possibly increasing the risk of premature birth). These effects are seen mainly in women who use marijuana regularly (six or more times a week).
In one of the larger studies on prenatal marijuana exposure, published in the journal Pediatrics in 1994, Melanie Dreher, PhD, along with two of her colleagues, undertook an ethnographic study in Jamaica. The research focused on neonatal outcomes from the mothers' marijuana use during pregnancy. Results did not show any differences, at 3 days old and at one month old, between newborns exposed to marijuana in utero and those who hadn't been exposed. Why Jamaica? From the report,
With regard to the research context, it should be noted that virtually all the studies of prenatal exposure have been conducted in the United States and Canada where marijuana use is primarily recreational. This is in marked contrast to other societies, such as Jamaica, where scientific reports have documented the cultural integration of marijuana and its ritual and medicinal as well as recreational functions. [n14,n15] Previous studies have had difficulty controlling possible confounding effects of factors such as polydrug use, antenatal care, mothers' nutritional status, maternal age, SES and social support, as well as the effects of different caretaking environments, which could lead to differences inneonate behavior. The legal and social sanctions associated with illicit drug use often compromise self-report data and render it almost impossible to obtain accurate prenatal exposure levels. [emphasis added]
In a study carried out in Canada, "Survey of Medicinal Cannabis Use Among Childbearing Women," researchers looked specifically at how 84 women who used marijuana during pregnancy to treat nausea, vomiting and hyperemesis gravidarum rated the effectiveness of "cannabis therapy." The women were recruited through "compassion societies" - where they receive medical marijuana. The authors found that almost all of the women--92 percent--found cannabis to be "extremely effective" or "effective" for treating nausea and vomiting; and suggested that the use of marijuana to treat "severe nausea and vomiting" certainly warranted further investigation.
The evidence may be minimal but some physicians and midwives are suggesting marijuana use for extreme vomiting and nausea during pregnancy - regardless of the state of criminalization. One midwife I spoke with, who preferred that I do not use her name, told me:
"I do encourage moms to use marijuana in moderation and only as needed for extreme nausea and vomiting in early pregnancy. I also tell them that marijuana has an estrogenic effect and that overuse could theoretically disrupt early pregnancy hormones and place someone at risk for miscarriage, but it's not likely."
On Momlogic.com, women share stories of their physicians suggesting marijuana use as well. Writing of her horrific experience with vomiting and nausea during pregnancy, Jessica Katz wrote:
Even though I am taking Zofran again, I am deathly ill. Now, I know that while you're pregnant you are supposed to limit caffeine, stop eating sushi and nitrates and not even touch Excedrin. So you can imagine my surprise when my doctor suggested marijuana as a treatment for morning sickness. I was floored. I am pretty sure that you are not supposed to do drugs in general, let alone when you are carrying a child. Don't they take your kids away from you if you do drugs while you are pregnant?
I went home and Googled this remedy. Could it be real? I found page after page of moms saying they'd used medical marijuana to treat their severe morning sickness, and that it had worked.
Other pregnant women on the site rushed to tell her she wasn't alone:
"If I [hadn't smoked] marijuana when I was pregnant with my second child, I would have never eaten," wrote Anonymous. "The smell [and] taste of food made me so sick I couldn't stand it. I didn't do much -- just a small hit, and then I was fine. If [your doctor] said it will help, believe him."
On Babycenter,com, when one of their "pregnancy experts" dared to suggest that marijuana use during pregnancy, was shown to be unsafe through studies, and equated it with smoking tobacco, currently and formerly pregnant women rose up, to dispute his claims:
I SUFFERED FROM THROWING UP, NOT BEING ABLE TO DIGEST ANY FOOD AND EVERYTHING ELSE ASSOCIATED W/ MORNING SICKNESS & THE ONLY THING THAT RELIEVED ME FROM IT WAS IF I SMOKED A LITTLE WEED.
I am a toxicologist, and nothing saddens me more than patronizing "professionals" like Mr. Briggs who present unsubstantiated speculations as facts. It is far too easy in this society to scare women with such misinformation...
My message to the Mr. Briggs of the world is to stop patronizing women and admit that it is HIGHLY likely given the generations of people born to women who smoked marijuana (or had a couple beers for pete's sake!) during pregnancy, that this is not a 'drug' worth demonizing.
But when pregnant women do resort to utilizing cannabis to treat extreme vomiting, appetite problems and malnutrition, they may be placing themselves in danger - not only in terms of the criminalization of possession in states where medical marijuana is not legal. They are leaving themselves open to being drug tested after their baby is born and then potentially prosecuted for child abuse and neglect. It's the "Alma Baker' scenario mentioned above. Says the midwife with whom I spoke:
"I counsel women that if there is a hospital transfer and the hospital conducts a drug test that she could be placing herself and her baby at risk of some unwanted intervention."
In states where medical marijuana laws apply, pregnant women are allowed to use marijuana to treat pregnancy related symptoms. Sabrina Fendrick of NORML (National Organization for the Reform of Marijuana Laws) Women's Alliance told RH Reality Check that just because a pregnant woman is allowed to access marijuana for medicinal purposes in those states where it's legal, it doesn't necessarily mean that she'll be automatically protected when it comes to drug testing, however. And in those states where marijuana use is illegal, Fendrick says she receives emails "at least once a week" from mothers who are in danger of losing their children after having tested positive for marijuana use after giving birth.
In South Carolina in 2009, a mother who had used marijuana during pregnancy was prosecuted for child abuse and no less than three medical experts came to her defense to decry the lack of any evidence of physiological, emotional or mental effects from the marijuana use. Dr. Deborah Frank, Harvard educated, Board certified in Pediatrics, and a Professor of Pediatrics at Boston University's School of Medicine not only found no evidence of abuse but said the child "appeared to be doing very well" and was developing in a positive way. Dr. Peter Fried, a PhD in Psychology and a retired Professor from Carleton University in Ottawa, Canada has done extensive research on prenatal exposure to marijuana. Though he's found some potentially negative effects, in this case, he stated clearly that "to characterize an infant born to a woman who used marijuana during pregnancy as 'physically abused" and/or neglected is contrary to all scientific evidence. The use of marihuana during pregnancy has not been shown by any objective research to result in abuse or neglect."
This isn't a question of whether or not marijuana can be used as a medicinal for particular, chronic, extreme conditions during pregnancy. Pregnant woman around the world are already doing what they need to - to keep themselves happy and to keep their fetuses growing and healthy. Physicians and and midwives recognize the medicinal properties and prescribe the use of marijuana in certain cases as well. Citizens are fighting to pass laws which do the same. Reproductive justice advocates may be understandably nervous about a potential alliance with advocates who work on drug policy issues. Considering anti-choice politics make it next to impossible to engage in an evidence-based discussion on the risks vs. benefits of medicinal marijuana in pregnancy, it's extraordinarly difficult to have the "adult conversation" advocates like Lynn Paltrow work so hard to sustain. Laws that serve only to control the lives of pregnant and parenting women, at the expense of both women's and children's health and safety, are born from anti-choice legislators and advocates. In the now, we have pregnant women in this country that are either forced to turn to illegal drugs in order to experience relief from, at times, a life-threatening condition or find themselves embroiled in a legal system which seems to prioritize laws in the abstract over what's truly in the best interest of mother and child.
This post was originally published at RH Reality Check, a site of news, community and commentary for reproductive health and justice