In early January 2015, Trinity Dogood started vomiting and couldn’t stop.
“I thought I had food poisoning or an awful stomach bug,” Dogood said. But after three days, the vomiting still hadn’t subsided, and Trinity found herself in the ER of a local hospital, begging for relief.
When the triage nurse took her blood for testing, they discovered she was pregnant.
“I was shocked,” Dogood said. The pregnancy was wanted, but unintentional. Doctors released Dogood and advised her to take more vitamin D and spend time outside to treat what they thought was standard morning sickness.
“I didn’t get much medical advice other than that,” Dogood said.
After two more weeks of continuous vomiting, it became clear to Dogood that what she had wasn’t run-of-the-mill morning sickness.
“At one point,” Dogood said, “I had my sea bands on, I had peppermint oil on my stomach and lemon oil in my nose. I was eating a ginger chew and I still threw up.” Fearing an adverse effect on the baby, Dogood refused any prescription meds for the first trimester, including Zofran, which is sometimes prescribed for pregnant patients with severe nausea. Zofran is labeled as a Category B drug by the Food and Drug Administration, meaning that there is no research that can conclusively prove it is safe for fetuses. For this reason, Dogood “wanted to hold out until the second trimester [for Zofran].”
As Dogood researched natural remedies for morning sickness, she discovered a rare complication of pregnancy called Hyperemesis Gravidarum (HG), which is diagnosed in 1 to 3 percent of pregnancies—an underestimate, according to HelpHer.org. HG is characterized by severe and unrelenting nausea and vomiting, extreme dehydration, weight loss, and even fetal demise. Physically and psychologically, the effects can be devastating. Some women have opted for termination, even in wanted pregnancies, because the symptoms are often so severe.
Dogood’s symptoms fit the bill for HG perfectly. “I woke up every day around 4 or 5 a.m., like clockwork, just puking,” Dogood said. In the beginning, Dogood vomited “upwards of 30 times per day” and was barely able to care for her older children. “I would just lie around,” she said. “I only got up to change a diaper or puke.”
Miserable, non-functioning, and terrified of Zofran, Dogood decided to give medical marijuana a try.
In 23 states, including Dogood’s home state of Arizona, marijuana is recognized for its medical benefit and can legally be prescribed to patients by doctors. According to 24/7 Wall St., 11 more states have taken steps to decriminalize marijuana and will likely legalize it, either for recreational or medical purposes, in the near future.
But for pregnant women, getting legal marijuana is a different beast altogether. Even in states where medical marijuana is legal, such as Arizona, physicians must sign off on a medical marijuana license—and most refuse when the patient is pregnant.
Perhaps this isn’t surprising. The American College of Obstetrician and Gynecologists (ACOG) has repeatedly warned against using marijuana in pregnancy, citing insufficient data to determine any harmful side effects. “In the absence of data,” ACOG states, “marijuana use is discouraged.”
In some states, pregnant women can even be arrested for marijuana use, in violation of so-called “Chemical Endangerment Laws” that are swiftly gaining popularity.
In 2014, when the state of Tennessee passed a chemical endangerment law, 28 women were arrested within the first six months of its enactment. According to AI.com and ProPublica, marijuana was the drug most listed in the arrest affidavits. Due to the high rate of arrest, the ACOG released a joint statement in June 2015 stating that although marijuana use is not recommended during pregnancy, women who decide to smoke should not be treated punitively. “Drug enforcement policies that deter women from seeking prenatal care are contrary to the welfare of the mother and fetus,” the statement reads.
Dr. Anthony Anzalone, a general practitioner from New Jersey, agrees that marijuana could be potentially risky for the fetus. But, he says, the risks of untreated HG could be even more harmful.
“I did obstetrics for 25 years,” said Anzalone. “On a scale from one to 10 [in terms of severity], Hyperemesis Gravidarum is off the charts.” In Anzalone’s clinical experience, “Hyperemesis creates a lot of problems,” ranging from severe weight loss to electrolyte imbalances, and worse. For such a severe condition, Anzalone says, “marijuana would help tremendously.”
Anzalone is one of the few physicians who oversee the New Jersey’s medical marijuana program. He makes recommendations to the state for which of his patients should qualify for medical marijuana. When the state issues them a marijuana license, the patients visit Anzalone in conjunction with their own physician to decide what kind and what amount of medical marijuana best suits their need. New Jersey’s program is similar to the one Arizona runs—but unlike many physicians in Arizona, Anzalone is one of the few that would prescribe MMJ to pregnant women, if he could.
“We don’t prescribe it to pregnant women because of malpractice lawsuits,” he said. “If something were to happen to the fetus, [people] would try to blame it on the marijuana.”
But Anzalone is convinced that medical marijuana would benefit pregnant women with Hyperemesis, and fully advocates for its use in pregnancy—as long as it’s tightly regulated and managed responsibly.
“The problem comes when you buy it off the street,” Anzalone said. “It can be very dangerous when it’s used recreationally because you never know what’s in it.”
But through environmental changes like moisture and cross-breeding, Anzalone said, centers could grow medical marijuana with a low amount of THC, meaning that it would be therapeutic for the patient but not incredibly potent. “If you keep the psychoactive component to a low amount, you don’t need a lot,” said Anzalone. And a small amount of marijuana could make a huge difference.
“You have to weigh the risks and benefits,” Anzalone said. “I think it would save a lot of medical needs and hospital visits. It would save a lot of money. You can control vomiting and weight loss. And then when the patient is stable and out of the hospital, they can stop [using].”
Eight weeks into her pregnancy, Dogood was desperate to control the vomiting. One night, Dogood’s boyfriend came home to find her “laying on the couch, in tears, vomiting up stomach acid.” Crawling off the couch, still retching into a bucket, Dogood followed her boyfriend outside onto the porch where he produced marijuana for them to smoke together in the hopes that it would stop the vomiting. “I couldn’t stop heaving long enough to take a hit from the pipe, so he took a hit and blew it into my face,” Dogood said. Within 30 seconds, she had stopped retching.
“I started to sob,” Dogood recalled, and within minutes was able to take hits from the pipe herself. Slowly, Dogood recognized a familiar sensation, one she hadn’t felt in weeks—hunger. Cautiously, she tried a slice of pizza...and then quickly wolfed down another. And another.
She kept all three slices down, the most she had eaten in months. “I was so excited. I was so relieved not to be puking. I knew all I needed to do was find a doctor [who could prescribe marijuana] during pregnancy and I’d be all set.”
But finding a doctor on board with Trinity’s treatment plan ended up being harder than she anticipated. When Dogood met with an OB at 18 weeks gestation and was upfront about her usage, the OB informed Dogood that she would be reported to Child Protective Services (CPS) when the baby was born. Dogood was devastated. “I was petrified that they were going to take all of my children, not just my new baby,” she said.
In order to test clean and avoid CPS at the hospital, Dogood decided to quit marijuana at 36 weeks and power through the rest of the pregnancy on Zofran alone. “I spent the last month of pregnancy begging for someone to kill me,” Trinity said. “I begged for it to be over. I begged [my boyfriend] to cut [the baby] out of me.” Trinity counted the minutes until her scheduled C-section—literally. “When I was bent over my trash can heaving up stomach acid, in tears...I would stare at the clock and watch the seconds just fall away.”
In late September 2015, after nine continuous months of sickness, Dogood delivered her “perfect” daughter by planned cesarean section. Dogood tested negative for marijuana—but the baby tested positive. CPS was called immediately.
“I was shaking,” Dogood said, when doctors informed her that CPS was on the way. “And my chest was hurting from anxiety.”
When a CPS worker finally showed, Dogood was questioned for over an hour. Terrified CPS would take the baby, Dogood refused to let anybody else hold the baby for the entirety of their visit. “She never left my sight.” CPS ended the visit amicably, but promised future visits to Trinity’s house and interviews with her older children.
Dogood’s nightmare with Hyperemesis Gravidarum is finally over, but her nightmare with Child Protective Services has just begun. Having already endured a second CPS visit at her home, Dogood’s family is now waiting for the agency to process their hair samples. If the family tests clean for marijuana, Dogood says, the case will be closed.
Regarding her drug use, Dogood doesn’t regret her choice. “I’m convinced it would have been much worse if I hadn’t [smoked],” she said. Dogood does, however, look forward to the day her family is no longer under scrutiny. “CPS scares me to death,” she said.
In the meantime, Dogood and her family will love on the new baby—and wait.