As her son, JD, and her husband, Juan, played in the backyard this past June, Kim tottered into the living room of her suburban Maryland home clutching a small, Sherlock-style glass pipe in one hand and cradling her pregnant belly in the other. She lowered herself into a gray armchair, sparked the bowl, and exhaled a tight column of white smoke from her lips, filling the room with a dank musk.
"I would be shocked, too," she said, sensing the strangeness of the scene—a woman 32 weeks pregnant smoking pot—"if I wasn't in this situation."
Kim, who asked that her last name be withheld, suffers from hyperemesis gravidarum (HG), a condition roughly one in 100 pregnant women face, characterized by debilitating nausea and vomiting that can last well past the first trimester of pregnancy. HG devastated Kim when she was pregnant with JD, now three and a half years old, landing her in the hospital multiple times for dehydration, leaving her incapacitated, and resulting in substantial weight loss.
"I was throwing up all the time. It's morning, noon, and night sickness all day, and it lasted all the way until the day I gave birth," she told me. "I was so sick we were even thinking about terminating this pregnancy, and that's not us. We're pro-life people."
After she tried Zofran, an anti-nausea medication originally developed for cancer patients, and a handful of homespun remedies like aromatherapy and acupressure bracelets, Kim chose to smoke pot for its immediate effectiveness in stanching the nausea and helping her muster an appetite. Even though there is no legal way to buy marijuana in Maryland, Kim, who was an Air Force intelligence language specialist and claims she was never a stoner, smokes a few times every day and especially before mealtimes. As a plateful of deep-fried, beef-stuffed empanadillas sat steaming on the kitchen counter, Kim confided that even she questions her choice to medicate with marijuana. "What am I doing, as a pregnant woman, doing this?"
From the moment a sperm fertilizes an egg, a rapid and complex biological mechanism transforms molecules inside a woman's body into the molecules of what, about 40 weeks later, will become a new human being. While the astounding intricacies of fetal development have only been functionally understood for a few decades, the specialness of pregnancy is hardwired into humanity's cultural imagination, not-so-subtly signaling to pregnant women, As you carry the future of our species within your womb, don't fuck this up. Limit caffeine, take folic acid supplements, monitor physical exertion—the list of ways women are supposed to alter their lives to accommodate for their growing fetuses is long, and mostly reasonable. Cigarettes and alcohol are verboten, given what medical science has shown they can do to the fetus; certain prescription medications should be avoided; and of course, don't smoke pot.
But women like Kim and others, who find pot to be a gentler and more effective alternative to a raft of pharmaceutical medications often prescribed to treat the corporal realities of pregnancy—like nausea, vomiting, pain, and depression—are challenging that notion. Still, I heard from many pregnant women and mothers whom I spoke with that smoking pot during pregnancy is an unlikely front in the broader political battle over women's healthcare and autonomy over their bodies, especially as those bodies carry new life. Does potential harm to a fetus, even when there's clear benefit to a pregnant woman, indicate poor judgment? How should child welfare authorities and doctors respond to pregnant women who smoke pot? Should moms-to-be, like Kim, feel guilty?
According to a recent survey by the federal government, nearly 4 percent of pregnant women admit to having smoked pot in the past month. Given marijuana's increasing acceptability as a supposedly legitimate treatment for a growing list of health conditions, Dr. Ira Chasnoff, a pediatrician and researcher specializing in prenatal alcohol and drug exposure, fears that that percentage will grow as more states legalize pot. Writing in the American Journal of Obstetrics & Gynecology in January of this year, Chasnoff analyzed studies detailing cannabis's effect on the fetus, concluding that tetrahydrocannabinol (THC), the psychoactive ingredient in pot, crosses the blood-brain barrier in the fetus and could impair a child's cognitive functioning. Citing two studies that tracked children of women who smoked cannabis while pregnant, Chasnoff wrote, "By age 10 years, prenatal marijuana exposure was significantly related to increased hyperactivity, impulsivity, and inattention problems as well as significantly increased rates of child depressive symptoms." His conclusion is that doctors should not recommend medical marijuana to women of childbearing age until after they've taken a pregnancy test.
In contrast to fetal alcohol syndrome and the effects of nicotine, there is no medical consensus that prenatal cannabis use affects the physical development of the fetus. Still, some researchers believe it could alter the cognitive functioning of children as they grow older. Since it's unethical to perform double-blind clinical trials of pot's potential negative effects on pregnant women, which is to say researchers can't give one set of pregnant women weed and another set a placebo and see how their kids turn out, the studies Chasnoff cites are, by nature, imperfect. Nevertheless, some of them show a clear correlation.
Chasnoff is no stranger to the field of prenatal substance abuse. In 1985, he published findings in the New England Journal of Medicine of the behavioral differences of just 23 babies whose moms used cocaine, which the media and child-welfare authorities predicted would precipitate a generational spate of birth defects. The so-called crack baby epidemic turned out to be false; follow-up studies showed that children born to women who used cocaine were in no worse health than other children born in similar socioeconomic conditions.
Prenatal cocaine use may have ill effects on developing fetuses but not more so than factors like poverty, hunger, or lack of access to prenatal care. What the crack-baby-epidemic-that-wasn't put in stark relief was how quickly women, especially women of color, are demonized for prenatal substance use, whereas richer women simply don't face that level of scrutiny, even when prenatal drug use remains relatively constant across racial and socioeconomic lines.
This social stigma has real-life punitive consequences. When mothers or newborns test positive for drugs like THC, agencies like Child Protective Services (CPS) or other state and local authorities have the power to investigate families, bring action in family court, and potentially remove children. In Alabama, a state with fetus-endangerment laws on the books, women can even be criminally liable for testing positive for THC and be held on bail as high as $100,000. Nationwide, children typically are not removed from families solely because of marijuana use, but the threat of social service intrusion deters some pregnant women from honestly talking to their doctors about their prenatal-health needs and concerns, which could have a worse impact on the health of the baby and of the mother than marijuana use.
When Kim saw her obstetrician in Maryland last February, supposedly routine blood work returned a positive test for THC, ensuring that Kim and her newborn would both be tested right after delivery, and that CPS investigators and social workers would visit her in the hospital after the birth. "I'm real scared about what's gonna happen at the hospital." The usually poised and reserved former servicewoman broke down on her back porch. "I'm not worried about actually giving birth. I'm worried about afterwards what's gonna happen with CPS."
To avoid a positive test, Kim decided to try to quit pot seven weeks before her due date, hoping traces of marijuana in her blood would have left her system. While she was unsure that quitting would in fact lessen the risk of CPS involvement at the hospital, at the very least she was optimistic that if she tested clean, it would help her case by showing she was at least trying to quit pot.
I went back and visited Kim at her house the first morning after she stopped smoking. She was in rough shape. Between half a dozen bouts of retching in her downstairs bathroom over the course of an hour, Kim lay down on her couch clutching a towel and holding back convulsive sobs. It was hard to watch and, in a sense, more shocking than seeing her light up a few days beforehand. Since her son JD was born, Kim has miscarried two pregnancies, and she blames the visceral toll that vomiting takes on her body as a decisive factor in losing those pregnancies. While women with HG aren't shown to miscarry more often, it was difficult in that moment not to see some connection between her suffering and the inability to keep a pregnancy viable without medication to control her vomiting. Days later, Kim decided to start smoking again to control those symptoms, despite the damage it might do to her credibility with CPS.
Even if CPS's surveillance has the best of intentions, Lisa Sangoi, a former litigator of child-welfare cases and research fellow at New York University School of Law Family Defense Clinic, who's finishing an advocacy report on substance abuse and the child-welfare system, believes that the agency operates on faulty, "preconceived notions of what healthy child-rearing looks like." In many states, healthcare professionals are not required to test women for controlled substances or report those findings to authorities if they come back positive. But they sometimes bring CPS into the picture anyway. "Your children can be removed from your home even before there has been a decision that you're abusive or neglectful, on the theory that they face imminent harm." To Sangoi, this reads as de facto punishment for something that's not actually a crime. "You'd be surprised to learn that testing positive for marijuana is not illegal."
And simply legalizing pot might not be a silver bullet. According to Sangoi, there is "evidence in Denver that Child Protective Services' activity around marijuana has increased since legalization." Even if there could be negative effects from prenatal cannabis use, that doesn't sanction aggressive state intervention. "When we start to police risk of harm, what we're really policing is just the act of being pregnant itself. And we're creating a whole separate class of actions that are prohibited only for women."
What cases like Kim's demonstrate is how broader political battles about women's bodies are being waged in the womb. The findings of Sangoi's report are not all that surprising: Poor women and women of color are subject to far more scrutiny than wealthier and whiter pregnant women. As pot is legalized throughout the country and fears that pregnant pot smokers are harming their babies spread, "the child welfare system is ground zero for the war on drugs," Sangoi said.
When I posed the question to Kim whether she had considered that perhaps her body simply couldn't handle another pregnancy and that maybe she shouldn't have another child, she was unambiguous. "Why wouldn't I want to have more kids? I like being a mom. Your typical nuclear family, that's what I wanted. A boy and a girl, that would be perfect."
Krishna Andavolu is the host and executive producer of Weediquette on VICELAND. Watch the episode "High-Risk Pregnancies," premiering October 17.
Additional reporting by Conall Jones and Nora Wilkinson