Supporting Women Who Consume in Ways that Work
Wading through the Weeds is an on-going research project aimed to translate and mobilize new knowledge to improve public health approaches to supporting Black, Indigenous and other unjustly marginalized individuals who consume cannabis during pregnancy, breastfeeding, and motherhood. Building on a small body of critical health and social science research, this work aims to centre Mothers’ stories.
Pregnancy, Breastfeeding, and Parenting
Publications
Wading Through The Weeds:
A Public Health Response to Supporting Pregnant and Breast/Chestfeeding People who Consume Cannabis
“Digging in”:
Stigma and surveillance in the lives of pregnant and breastfeeding mothers who consume cannabis
Objectives
The two primary objectives of the Wading through the Weeds Project are:
Garner the experiences of Black, Indigenous, and other unjustly marginalized pregnant and breast/chestfeeding individuals to identify and shape how public health policies and practices can effectively respond to their lived realities; and
Generate new knowledge to strengthen public health and allied health care policies and practices that will increase access to perinatal and parenting information and support for pregnant and breast/chestfeeding individuals who consume cannabis.
Key Research Questions
Where do pregnant and breast/chest feeding individuals who consume cannabis access public health information before, throughout and following the perinatal period?
How do pregnant and breast/chestfeeding individuals interface with current cannabis policies, practices and regulations?
How do pregnant and breast/chest feeding individuals who consume cannabis envision health and public health cannabis policies and practices that are accessible and supportive?
“The Flower Brings Me Solace”
Background
In 2018, Canada legalized recreational cannabis. This has had significant shifts on the landscape of health and social policy and had implications for health and social care providers. As legalization becomes more entrenched, cannabis related surveillance, stigma and punishment still looms large for marginalized communities. Our project builds on a small body of critical health and social science research that focuses on cannabis use during pregnancy, breastfeeding and the postpartum period.
Cannabis is one of the most widely used substances during pregnancy across Canada
(Corsi et al., 2019a; Corsi et al., 2019b; Krenig & Hanson, 2018; Mets & Stickrath, 2015). Some Canadian studies document up to 5% of pregnant women self-reporting cannabis use (Ryan et al., 2018; Young-Wolff et al., 2019)., Kaarid and colleagues (2021) recent research on the prevalence of cannabis consumption for pregnant women living in urban cities in Canada, found that among the 478 respondents, 54 (11%) reported consuming cannabis at some point during their pregnancy. And yet, studies such as these, that rely on self- reported data are likely to under represent the current reality (Ryan et al., 2018).
Cannabis related stigma and surveillance is shaped and further exacerbated by intersecting identities along axes of Indigeneity, race, socio-economic status, disability, criminalization, child welfare involvement and HIV status.
People who face existing injustice in health and social care settings have concerns about approaching health and social care providers for information, support and education about cannabis consumption during pregnancy, breast/chestfeeding and postpartum.
During the time of cannabis prohibition, Black, Indigenous, and racialized communities have been subjected to greater surveillance and have faced harsher penalties for cannabis consumption and possession (Schlussel, 2017; Vitiello, 2019). Despite legalization, Black and Indigenous mothers continue to experience increased surveillance and unjust consequences because of cannabis use (Boyd, 2019).
The Wading through the Weeds Project seeks to respond to the anti-Black racism that continues to exist in Canadian health and public health policies and practices, and the Truth and Reconciliation Commission: Calls to Action (2015, p. 2-3) to “address gaps in the health, public health policy and healthcare practices between Indigenous and non- Indigenous peoples.”
Research from a gendered and intersectional theoretical lens on cannabis consumption
is limited.
Furthermore, research demonstrating positive health outcomes or perceived improvements in women’s quality of life in relation to cannabis consumption are often not included in the body of “evidence” used to derive guidelines and inform clinical practices
(Kozak, Ion & Greene, 2022).
Currently, multiple public health, obstetric, and pediatric organizations advise against cannabis consumption while pregnant and breastfeeding (Committee on Obstetric Practice, 2017; Health Canada, 2018; Ryan et al., 2018). And yet, there continues to be a lack of conclusive evidence regarding possible adverse effects of cannabis consumption during the perinatal period (Barlett et al., 2020; Jarlenski et al., 2016).
It is acknowledged by researchers that pregnant women who consume cannabis are more likely to be affected by the social determinants known to impact health including racism, colonialism, poverty, mental health challenges, trauma, and other concurrent environmental and social factors (Bartlett et al., 2020; Greene et al., 2016; Ion et al., 2017; Jarlenski et al., 2016).
We echo previous scholars who have noted that cultural, economic, and social factors can shape birth outcomes more broadly and call for an intersectional approach to understanding cannabis consumption during pregnancy, breast/chestfeeding and the postpartum period (Dreher et al., 1994; Nugent, 1994).
There has been a call for increased knowledge at the intersections of gender and cannabis consumption and a need for more research that elucidates how gender roles and relations and identities, intersect with the health and social consequences of cannabis use to “inform more responsible health promotion, effective harm reduction and precise treatment approaches for all genders” (Greaves & Hemsing, 2020, p.11).
The Wading through the Weeds Project offers a critical response to this call by using a participatory arts-based approach to researching with pregnant and breast/chest feeding individuals who consume cannabis across Canada.
We Don’t Want to Wade Through the Weeds for Actual Factual Information
Key Findings
1. Centring Lived Experience:
Currently the majority of research around the intersection of pregnancy, breastfeeding and parenting is from the perspective of public health and health based researchers. The experiences of people who consume cannabis and who occupy marginalized identities are particularly absent from the research.
There is a need for supporting research that centres lived experience throughout the research process. This research must be grounded in anti-oppressive values that acknowledge the histories of racism, colonialism and poverty.
2. Moving Beyond Discourses of Risk vs. Discourses of Resilience:
When research is done around perinatal experiences and cannabis consumption is positioned within discourses of risk, both in terms of public health and social care. What is absent from the current discourse are the perceived and actual benefits of cannabis consumption particularly in the context of mental health and wellbeing.
3. Stigma and Surveillance:
Although cannabis has been legalized in Canada since 2018, people who consume cannabis face stigma, specifically those who have been historically surveilled in health and social care contexts (ie. Black, Indigenous and Poor Women, those Living with HIV and living with mental health concerns).
Discourses of risk perpetuate the stigma and surveillance of marginalized pregnant, breastfeeding and parenting individuals. This occurs in health and social care contexts where these individuals face a high level of surveillance and monitoring of their cannabis consumption.
This leaves people feeling criminalized and in many cases live in fear of having their children apprehended because of cannabis related concerns.
4. Access to Care and Information on Cannabis During Pregnancy, Breastfeeding and Parenting:
The conditions outlined above make it high risk for mothers/parents** to seek out information, education and support from their health and social care providers about cannabis.
Consequently, parents make decisions that are not based on evidence. This is due to a lack of accessible information or availability of partial information, and morally based recommendations made by health and social care professionals; and partially because the consequences associated with reaching out can be punitive.
Participants seek out cannabis and pregnancy information through engaging in self- research, peer connection and virtual communities, and ancestral and traditional knowledge. While these sources of support are important, cannabis related information received can be contradictory and result in raising more questions than answers.
5. Supporting Mothers (and Birthing People) Who Consume in Ways That Work:
The Wading through the Weeds Project centres the perspectives and experiences of people who consume cannabis during the perinatal and postpartum period.
Supporting mothers who consume cannabis during pregnancy, breastfeeding and postpartum through a public health response must be grounded in anti-racist, de-colonial and harm reduction-based philosophies.
1. Identity, experience and culture must be considered when designing responsive frameworks
2. Develop non-punitive support, information and health and social care services with/for people who are pregnant, breastfeeding and/or mothering and consuming cannabis
3. Draw on what is already working including person-centred health-care frameworks (midwifery models of care), peer support and virtual community and culturally grounded approaches to care, information and support.
** All the participants in this study identify as mothers, however, we are including the term parents to ensure inclusivity of all genders who parent, experience pregnancy and infant feeding.
Brooklyn Bertozzi
“At the end of the day I need a little fresh air.
Some green flowers are my way of self care.”
Research Findings: Participants
Twenty-Three Mothers (approx 6 per workshop) participated in the workshops and included people from Ontario, Alberta, Saskatchewan, Manitoba and New Brunswick.
A common theme that emerged across all the Photovoice workshops and in response to all of the Photovoice questions was the relationship between the mothers’ stories of cannabis consumption and their mental health. Importantly, consuming cannabis during pregnan- cy, breastfeeding and mothering was a conscious decision that relied on personal histories, experiences, research and identity.
For many of the mothers who participated in the workshops, cannabis was used as a method of decreasing anxiety. This was voiced at different moments along the antenatal journey including pregnancy, breastfeeding and mothering. For example, AL, a young mother from Alberta shared how consuming cannabis during her pregnancy helped to her to “calm down”:
“My mental health wasn’t very well. I felt like I wasn’t in my own body. It was an out of body experience - pregnancy itself. And I was probably worried about things. And then with cannabis, I just felt like I was able to grow and I was able to calm down.”
Importantly, pregnancy can be an alienating bodily experience for people who have experiences of trauma. For AL, cannabis supported her to feel more connected and comfortable in her body during this mentally challenging time in her life.
These feelings can continue after the baby is born. As one of the young mothers, K, expressed, although she believed that breastfeeding was important and necessary, it also resulted in feelings of anxiety. At times, breastfeeding resulted in triggering a traumatic histor“y and in turn anxiety about the act of breastfeeding itself:
“I like nursing. I feel the bonding. But it’s also like because of what I dealt with my history. Sometimes when my anxiety is acting up, I don’t like the nursing, like I feel... I get the aversions feeling. So when I smoke, it really does help calm me down so I can better handle it”
Hence, K turned to cannabis as a calming factor that enabled her to breastfeed, something she felt was an important element of mothering. Reflecting on her choice to consume cannabis while breastfeeding, T an Indigenous mother who had a history of PTSD wondered about the potential of cannabis in helping her to prevent her fear of postpartum depre“ssion:
“I’m unsure how I’m going to still consume marijuana and breastfeed at the same time because I do want to breastfeed. But at the same time, I do still want to consume marijuana. It really, really helped with my PTSD. So I’m thinking, what if it helps with my postpartum depression?”
Regardless of whether or not the mothers chose to consume cannabis while breastfeeding, it was an ever present consideration, particularly for those mothers who continue to experience the effect of past traumas.
During one photovoice workshop one of the Indigenous mothers began sketching a willow tree to demonstrate the positive impact that cannabis has had on her to feel “rooted and grounded”:
“It’s a picture.... I haven’t finished drawing it, but I just... It randomly came to me and I couldn’t stop drawing. It’s a picture of like a willow tree, and like the trunk is kind of like a woman, like a figure of a woman, kind of like to represent me. And I think that like one thing that I would want to tell social workers is that smoking cannabis has actually made me become more stable and more rooted and grounded in being a parent.”
Here, S echoes others in describing how cannabis was viewed and experienced as a tool that enabled them to feel more present and focused in their mothering and as M shared, “a necessity for mental health”. Moreover, many of the mothers in this project were mothering under systemically constraining conditions such as intergenerational trauma, poverty, gender-based violence and parenting in the context of Covid. As shared in both imagery and narrative by one young mother, B:
“So for me, the rainbow in the middle of the grey sky is a metaphor for the role that weed played in my pregnancy and postpartum experience. I felt like everything was very dark and cloudy around me. And when I was able to indulge, I felt a sense of relief and hope, that I could see the beauty through all the bullshit. Weed gave me time to breathe past my physical, mental and emotional hardship.”
Racism, impacts of colonization, poverty, age and histories of mental health and addiction have resulted in the experiences of stigma and surveillance in all aspects of their lives including their perinatal and mothering journeys. The stigma and surveillance they bump up against in health and social care settings creates barriers to safe spaces where people can ask questions or discuss their cannabis consumption.
As one Indigenous mother shared:
“I’m in a bad place, I’m afraid to call crisis response or to call for help because then automatically... You have kids so they’re going to start opening a CAS thing... like that’s why I painted my black hand over my face, because it’s almost like we want to tell our stories and we want to say our point of view, but like we are so afraid of the consequences of that, that we don’t ask questions, we don’t find answers, we don’t tell our stories. We keep everything inside because we’re so afraid of the consequences.”
Despite the legalization of cannabis, the participants were acutely aware of the surveillance associated with disclosing their cannabis consumption to health and social care providers.
As one young mother stated:
“There are a lot of people who are now digging into different parts of your life simply because you are using cannabis.”
Consequently, most participants chose not to share this information. As one Black young mother, J, stated:
“I don’t even think I’ve ever even expressed to my doctor or midwives or doula. Like even though it was something that I was experiencing on my own, I never felt comfortable to talk about that. Because I already had an idea of where the conversation would go, and I would feel judged.”
The mothers were subjected to judgment at various times throughout their pregnancies, while breastfeeding and mothering. For example, when L disclosed to her OBGYN that she was using CBD for nausea, the environment shifted from one of support to one of surveillance:
“Once she found out I was using CBD for nausea, she like had a pharmacist call me. And she also tried to push Cipralex on me because I said I have an anxiety and stuff. And I was like, “You’re not even a psychiatrist. Like I have a psychiatrist. And you’re not her. So like maybe just stick to my vagina and the baby.”
Cannabis related surveillance also operated in the child welfare space. Importantly, mothers who had previous child welfare involvement in their lives or who witnessed the impact of child welfare involvement in the lives of others, expressed fear of what would happen if their cannabis consumption became known. This was exemplified by S, a young mother when she was sharing her experience of having a social worker over for a home visit:
“The woman comes to my house. I had to hide my cannabis plant because I’m like I don’t know how she’s going to feel about that. And one of her first questions to me was, do you consume cannabis?”
As a response to the stigma and surveillance associated with consuming cannabis during
pregnancy and breastfeeding one young mother stated:
“When people learn that I use cannabis in PP and while nursing, I think people assume I’m being negligent towards my baby’s health. On the contrary, here are ALL the supplements I use. Do you think I would spend all this $$ for nothing?”
This mother, echoing all mothers in this study, consistently finds herself in a position of having to defend her choices and position herself as a responsible mother as if she is committing a criminal offense. In the child welfare context, there has recently been a discourse that states that cannabis is not a reason for child welfare involvement. However, as this study has shown, this is not the case and in fact, participants from across the country report an initiation of a child welfare investigation as a result of their cannabis use during pregnancy and breastfeeding.
It is not surprising given the over-representation of Black and Indigenous children in care that the Black and Indigenous identified mothers in this study were deeply aware of the connection between racism and cannabis surveillance in their lives. As one Black mother articulated:
“This group is a group of like black parents, too, right. And it’s like because the criminalization of cannabis disproportionately affected the black community. I think that would be really powerful in how we talk about cannabis and how it relates to our lives as parents, right. And I’m just like really excited for this, to be honest, because like I see there’s parents, there’s one that’s expecting, right, there’s another one that’s breastfeeding. ... But like you can see like the vastness of like how parenting, and how we use and how we see cannabis as medicine. How we see it as something that helps us mentally, helps us physically, right. Like even spiritually. Like I think is great, right. I think the information needs to be accessible, right. And I think it would change... I think it could even change the stigma attached to it as well. Even though I’m sure that most of our relatives were smoking cannabis or using cannabis while their children were young. They just didn’t have a space to talk about.”
As shared by A, a Black mother, cannabis information is not accessible because of the stigma associated with cannabis use. Worries about the perceived and real consequences of stigma and surveillance of their cannabis consumption resulted in barriers to information on and about cannabis during pregnancy and breastfeeding.
“I’m literally facing the opposite towards information that should be accessible, that is not accessible, and no one feels really safe to communicate with because of the stigma tied to the use of cannabis.”
For those who participated in the photovoice workshops, this resulted in doing their own research to help them to make decisions about how and when to consume cannabis. Navigating the internet and connecting with virtual communities was the predominant mode of accessing information on the impact of cannabis on pregnancy and breastfeeding. However, the mothers were often met with little to no valuable information. One Indigenous mother described this experience as going down a blackhole:
“Yeah, so I drew a picture of basically like a black hole, like a void spiraling into a question mark. And that was basically how I felt about finding information and reputable, like you know, peer reviewed information on cannabis use and pregnancy and during breastfeeding, etc. It was very hard to find credible sources of information”
This was echoed by L shared who shared:
“When I typed in ‘is it okay to smoke weed before breastfeeding?’, absolutely zero information came up predictively... To me that means it’s one of those very little researched topics. That’s something that’s very little talked about as well, and there’s a very lack of information on it. And the research that we do find, I found very misinformed”.
The worries of being misinformed was a predominant worry that arose out of the absence of a trusted professional to ask questions about cannabis, pregnancy and breastfeeding. When. J, a Black mother from Ontario shared a photo of a broken telephone to accompany her narrative that had a double meaning - the absence of having a health or social care professional to talk to and the experience of receiving “mixed messages and mixed stories”:
“There’s mixed messages and mixed stories. And again, people are honing in on their personal experiences with things. So one person might share her experience of like, “Yeah, I smoked weed pregnant, nursing, while parenting. Nothing. I see no issues.” Another person might say, “I noticed some issues while I was pregnant, but I didn’t notice issues while I was nursing.” Another person might say, “I didn’t do it nursing or while pregnant, but now as a parent I smoke weed, and I’m not noticing issues.” So I think the message of this photo to me is regardless, like people might share their experiences but that’s what that is. It’s just their experiences. And we don’t have to take those as the end all, be all. We can interpret it how we want to. And we could choose to like dabble in whatever we want to do when it comes to this...The broken telephone to me signifies not speaking about cannabis use at all.”
The trending toward subjective interpretation was also an important theme. With most of the information on cannabis, pregnancy, breastfeeding and parenting coming from the internet, people were left with little choice but to make their own sense of the information available online. At the same time, this was a concern because there was also the acknowledgement that the information was not coming from reliable sources. As D, an Indigenous participant from Northern Ontario shared:
“You can find pros and cons for anything, and you can kind of make your own judgment about things. Which can be bad because people... A lot of people get their news from Facebook and their information from Facebook. And it can be bad. But you can kind of get like a hint of something, and then you start your own research. And so that’s what I do quite often”
Hence, while peer support felt non-stigmatizing and going online enabled a safe space to seek i“nformation, what women really wanted/needed was ‘evidence.’ As B shared:
“What we need is hard core facts, information, scientific studies. We just want to know so we can make our educated choices. And then we don’t have to feel guilty about it.”
This was a point that resonated across all mothers in the study. Having reliable information from credible sources would enable them to make educated decisions that took into account a range of issues to include mental health and well-being in addition to the health of their children.
At the same time, some of the mothers felt confident about their ability to educate themselves and to make decisions based on their culture, identity and education. For example, K shared an image that demonstrated the importance of bridging western education with ancestral knowledge:
***CDM TBC from pg 19/20
Conclusions
INTERPRETATION OF FINDINGS
The Wading through the Weeds Study emphasizes the importance of centering the lived experiences of mothers/parents in cannabis research in order to develop a client centered approach in the development of public health policies, practices and strategies.
Of central importance, our study highlighted the need for de-stigmatizing and harm reduction approaches at the intersection of cannabis education and perinatal care. Developing such models of education, care and support would address barriers that pregnant people and parents experience in connection to decisions they make regarding cannabis consumption. This was underscored by the participant’s resounding agreement for the need for more research on cannabis consumption during pregnancy, infant feeding and parenting.
IMPACT OF FINDINGS
Our project reiterated that participants from marginalized identities including Black and Indigenous parents and parents living with visible and invisible disabilities faced more cannabis related stigma and surveillance. Stigma and surveillance were particularly noted in participants’ interactions with the child welfare system and the health care system.
Fears associated with the above in the context of cannabis consumption during the perinatal period and beyond result isolation and silence. This prevents parents from seeking out health or social care support and having honest conversations about cannabis use during pregnancy and infant feeding with their care providers.
Participants in this study identified the need for more information and education relating to cannabis consumption during the prenatal period to inform their decision making. There is a concern then that current public health strategies (including available information and resources) do not reflect the everyday realities of people who desire or need to consume cannabis during pregnancy, infant feeding and parenthood.
Policy Impact
1. Further Develop Harm Reduction-Based Supports During Pregnancy and Postpartum For People Who Consume Cannabis
Our findings brought attention to the lack of perinatal care that is grounded in the histories (political, economic, social and personal) and every-day lived experiences of mothers/ parents who consume cannabis during pregnancy, infant feeding and parenting.
We strongly urge further developing models of public health and social support for people during pregnancy and the postpartum period that is grounded in a harm reduction approach.
2. Co-create Information and Resources Relating to Cannabis and the Perinatal Period
Participants in our study called attention to a lack of accessible information on cannabis consumption during pregnancy and infant feeding.
We encourage the development of new types of educational tools and resources (virtual, arts-based) that provide information on cannabis and pregnancy/infant feeding. We suggest researchers work collaboratively with mothers and parents who use cannabis when designing new resources to ensure resources address the needs identified by mothers who consume cannabis and are widely accessible.
3. Enhance Capacity of Health, Social Care and Child Welfare Workers Who Support People Who Consume Cannabis During Pregnancy and Postpartum
Stigmatizing interactions with health and social care providers emerged throughout the Wading through the Weeds project.
We call for the development of enhanced training and capacity building opportunities for health and social care providers relating to cannabis, pregnancy and parenting grounded in the context of legalization. There is a particular need for education, training and support for child welfare workers who work with people who consume cannabis during pregnancy and parenting.
Training needs to focus on working towards less stigma, surveillance and punitive interactions based on cannabis consumption. Findings from this project and other research that centres lived experience offers important content that could be used as the basis of a training.
4. Support and Care That Works
Participants in our study offered considerable information about what they need to be well supported in relation to cannabis consumption during pregnancy and postpartum.
This includes connection to culture, communities of care for mothers, peer-based support, and trustworthy and reliable care providers. Our findings show that from a public health perspective, there is a lot to be learned from midwifery models of care, centring choice, relational-based support, and trauma-informed approaches.
We encourage the development of new community-based public health and social programs for people who consume cannabis during pregnancy, infant feeding and postpartum.
Thank You To Our Participants
We want to send a special thank you to all the mothers who chose to participant in this study.
Without their vulnerability in sharing their stories and experiences,
we would not have been able to accomplish any of this.
Thank you to all of you for being so open, authentic and honest about your experiences with Cannabis through pregnancy and feeding your children.
