1. Reasons for Prenatal Cannabis Use and Safety and Risk Self-Medication “You don’t have to be trying to get high out of your mind. I feel like that’s what a lot of people think it is…In reality, we’re using marijuana to be able to basically survive through this pregnancy in order to have the energy to get up and do these walks that they want us to do and be able to stretch and move and eat and get that water in.”

“I suffered from hyperemesis this entire pregnancy… I’ve lost around 50 pounds in the first trimester and [cannabis] was the only thing that made sure I could eat and take my prenatal vitamins.”

“I already struggled with sleeping… If I woke up in the middle of the night I could smoke a bowl and then in 20 minutes I could be asleep.”

Cannabis as natural and safer than medication “I had really bad nausea…. I got to like Zofran… They were just like, “There’s all these like possibly scary like side effects,” and I was just like, ‘Yeah. I think I’ll just start smoking again because that seems less scary.’”

“I’m very against any medication I do not need to take absolutely…. So I do feel like cannabis feels not just more natural but, like, closer to the source of what you’re getting.”

“Instead of taking [psychotropic] medications, [cannabis] kind of helped me better… and I feel like it will be way less harmful than the drug that they were giving me for bipolar or depression.”

Comparisons of cannabis with alcohol, and other substances “A lot of people don’t really view cannabis as like a drug…. They don’t put it on par with alcohol or like crystal meth… like, “I know that this will damage my baby.”

“Maybe not referring to cannabis as a drug would be easier…. Have a separate spot for it in the intake questions might be easier for some people to be honest with it because honestly… you have a separate thing for caffeine, why not have a separate thing for smoking marijuana?”

“Smoking [cannabis] to me was like drinking a glass of wine. So I don’t see anything wrong with that.”

Quitting due to potential harms “I do it because I like it, but I know that it’s not good for me. So, when I have another person in my body and it’s not good for them, I’m not going to just do that to them.”

“If something did happen or, you know, if my baby developed something, I would always wonder if it was because I smoked if it was something that I did. So, it’s just something that I just choose not to do so that I don’t have that worry down the road.”

“I don’t want to necessarily do anything to put the baby at risk. And so, I have tapered off my smoking of marijuana just because my paranoia of everything is up. I just wanted to be as perfect as possible because I'm a first-time pregnancy.”

2. Health Care Experiences and Patient–Clinician Communication Desired and Positive Health Care Experiences “Teach [doctors] how to bring [cannabis] up in a way that isn’t judgmental and be able to bring it up in a way that this is just an open, confidential conversation with your doctor. There’s no judgment here.”

“It’s really just the relationship you have with the provider, ‘cause even they views are different, you know, sometimes understanding people’s views that are different make your choices change, right? But I feel like if I’m comfortable with that person to be open-minded about what the feedback that they give you, like it’s easier for you to come and say, “This is what I’m doing. What do you think?”

“…Give me the information that I need and let that be it. Like, just straightforward. Don’t impose your beliefs, your thoughts, your values upon me or what you think is better for me. Like, let me make that decision.”

Off-Putting and Undesirable Health Care Experiences and Communication “I actually had a [clinician] that anytime my cannabis use came up, it was, ‘You need to put an immediate halt to that. That is a no-no. You can’t do that.’… So after, you know, the first couple of sessions of that, I was like, ‘You know what, if he ask me… I’m not going to lie to him, but I’m not going to be forthcoming with him either.’ And I ended up just having to change doctors. Because I feel like, what’s the point in having you if I can’t talk to you, you know?”

“I’ve noticed they say, ‘Sbottom doing this.’ And other than medicine, they don’t really offer any other options. They just say you need to quit. That’s the end of the conversation. They don’t say, ‘Well, here’s another way,’ or, ‘Do yoga’, or anything. They just say, ‘Quit.’ And it’s end of discussion.”

“I have my own opinion about smoking while you’re pregnant… If I think it’s okay and then you’re telling me, like, ‘Oh no, that’s just, like, it’s all bad,’ like, not even an inch of it being okay, I will just be like, ok, I’m not gonna – I won’t bring it up to you, you know, cuz I don’t see that, necessarily.”

3. Desired Cannabis Information Patients Seeking Information About Prenatal Cannabis Use “I remember I had stumbled across like this Instagram hashtag. It was like, ‘Moms who smoke weed,’ and it was just like pregnant women smoking weed.”

“I think there may be people using it and realizing that their babies “turned out fine.” So, you might have a friend who, who used it, and you may say, “Oh, well, you know what? At, at first, it was something I wouldn’t do. But since she did it and her kids are fine, maybe it’s okay for me to do it.”

“Deep dives into the Internet late at night, you can find anything. But I would say, you know, they weren’t necessarily you know, like journals or anything that are like really reputable from you know case studies or anything like that. I think that a few of them that I did read were from other countries like Australia and from Europe.”

Perceived limitations of research “The only risks that I have heard are just giving birth early or low birth weight. But I also know that there’s no definitive studies that show that that does happen. It’s just stuff that I’ve heard from people who are against [cannabis] mostly.”

“If you don’t want to take Zofran, then try some marijuana, and here are the benefits, and here are the risks. But right now, they’re just assumptions. Yeah, you could have a low birth rate. You could have lower cognitive ability in your child. Well, we could have that with other drugs as well, you know, but we don’t actually have the numbers and it’d be nice to have the numbers like we do with other medications.”

“When I was doing research on cannabis and how it affects the fetus, all it kept saying was there haven’t really been any studies. So, it was kind of inconclusive, but there haven’t been any marked, you know, adverse reactions, long-term or short-term.”

Desired Information and How to Best Receive It “I would like to see pamphlets that have bullets and then cited research next to them… so that I could look it up again on my own and gather more information and better understand and see why so I know it’s not just opinion or the cultural norm.”

“Classes, I feel like, are the most educational. You know, people sometimes don’t want to sit through that, and I understand that. But, just getting the knowledge, you know, in front of you. I’m like a verbal type, hands-on type of learner. So, to actually see something and like see charts and things like that, like to make it make more sense, get a better understanding of what it does, like I feel like I would feel more comfortable.”

“Even just a little bit of a conversation and maybe some backup information—a pamphlet or an email, fine. Either way. But a conversation that really opens the doorway to say, like, “Look. I know this is a reality in your life. I want to know about it.” And less talk about how negative it is. Let’s talk about it first. Then you can give me the negatives and the effects of it. But let’s just have an open conversation so that we can get that information out there.”