Prenatal care providers avoid cannabis conversations to maintain patient trust | Research

The takeaway

Maternal health providers in safety-net settings reported relying on self-education about cannabis, taking case-by-case approaches, and often avoiding cannabis discussions to preserve therapeutic relationships with patients.

Obstetricians, midwives, maternal health policy makers

Providers actively avoided cannabis discussions to preserve patient trust

What the researchers found

Interviews with 10 maternal health providers revealed three patterns: relying on self-education due to lack of formal training, taking case-by-case approaches rather than following standardized protocols, and actively avoiding cannabis discussions to maintain patient alliances. Providers recognized that reluctance to counsel overlooks the lack of resources and healthcare alternatives available to low-income patients.

Why it matters

When providers avoid cannabis discussions to preserve relationships, patients in safety-net settings lose access to one of their few sources of medical guidance, potentially reinforcing health disparities.

The numbers in context

10 providers interviewed (2 midwives, 6 OB/GYNs, 2 residents); all in Southern California safety-net settings; interviews conducted March-April 2022

How the study worked

Qualitative constructivist grounded theory study with semi-structured remote interviews of 10 providers (2 midwives, 6 OB/GYN physicians, 2 residents) in Southern California safety-net settings, conducted March-April 2022.

What this study cannot tell us

Small sample of 10 providers from one region. Safety-net setting focus may not reflect private practice perspectives. Self-selected participants may represent those more willing to discuss cannabis.

How to read the evidence

Small qualitative study with grounded theory methodology; provides rich contextual data but limited generalizability.

When this study was published

Published 2023

The bigger picture

The tension between maintaining therapeutic relationships and providing evidence-based counseling reflects a broader challenge in prenatal care as cannabis use becomes more normalized.

Questions still open

Would structured training and nonpunitive policies increase provider willingness to discuss cannabis? How do patients in safety-net settings perceive provider silence about cannabis?

Common questions

Why don't prenatal providers discuss cannabis with patients?

Providers cited fear of damaging therapeutic relationships, lack of formal training (relying on self-education), and uncertainty about the evidence. Some worried that raising the topic could cause patients to disengage from prenatal care.

How does this affect low-income patients?

Providers recognized that avoiding cannabis counseling particularly disadvantages low-income patients in safety-net settings who have fewer alternative sources of medical information and fewer treatment options for symptoms driving cannabis use.

Read the original research

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.

Women's health reports (New Rochelle, N.Y.), 4(1), 400-408

View on PubMed ↗Publisher’s paper ↗

Citation

Ceasar, Rachel Carmen; Gould, Erin; Stal, Julia; Laughter, Jen; Tran, Michelle; Wang, Shirlene D; Granacki, Jordan; Ziltzer, Ryan S; Santos, Jasmeen Joy. (2023). 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.. Women's health reports (New Rochelle, N.Y.), 4(1), 400-408. https://doi.org/10.1089/whr.2023.0057