Pregnant cannabis users and clinicians want the same conversation but rarely have it

Three phases of clinical encounters influenced cannabis decisions: initiating discussion, making sense of information, and the outcome. While clinicians described their approach as reflecting open, patient-centered values, patients reported that actual interactions did not match. Both groups endorsed nonjudgmental conversations exploring reasons for cannabis use against available evidence and known-safe alternatives.

Qualitative descriptive study with semi-structured interviews of 75 individuals in Canada: 23 perinatal clinicians and 52 pregnant or lactating individuals who made cannabis decisions. Data analyzed using inductive content analysis.

Cannabis use during pregnancy is increasing with legalization, but the counseling gap between what clinicians think they are providing and what patients experience creates missed opportunities for informed decision-making.

Legalization has made cannabis more accessible during pregnancy, but clinician training on the topic has not kept pace. This study highlights that even when clinicians have good intentions, patients feel the counseling they receive is inadequate, judgmental, or lacking in nuance.

Canadian study may not reflect practices in other countries. Self-selected participants may not represent broader populations. Clinician self-reporting may overestimate the quality of counseling they provide. Qualitative design captures experiences but not prevalence.