On May 4, 2019, Lindsay Ridgell gave birth to her baby boy Silas in Phoenix after a difficult pregnancy. She'd had hyperemesis gravidarum, a condition that causes severe nausea and vomiting, and had been hospitalized twice when she'd gotten so dehydrated she required IV fluids.
As soon as Silas was born, Ridgell said she could feel the nausea dissipate. But a few days later, a social worker showed up in Ridgell's hospital room, she said, and told Ridgell that she would be reporting her to the Department of Child Safety, Ridgell's own employer at the time. DCS then told Ridgell that it was placing her on Arizona's child abuse Central Registry for the next 25 years. The agency argued that Ridgell had neglected her newborn son by treating her hyperemesis gravidarum with medical marijuana.
This Wednesday, Ridgell and her attorney Julie Gunnigle will attend oral arguments at the Arizona Court of Appeals in an attempt to appeal the Department of Child Safety's decision and have Ridgell's name removed from the child abuse registry.
It is estimated that more than 10% of births each year in the United States are affected by illicit drug use. But what makes Ridgell's case unique is that medical marijuana is no longer illegal in Arizona.
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Many reproductive justice advocates believe the outcome of Ridgell's case is likely to set a precedent for how Arizona, and the rest of the nation, considers marijuana use during pregnancy, especially as the drug is increasingly decriminalized in states. More than 30 states have legalized medical marijuana, and 19, including Washington, D.C., allow recreational use.
"What we're seeing now are a series of cases in which despite the fact that medical marijuana, or marijuana in general, has been legalized, states are finding a way to target and subject people who are pregnant," said Lynn Paltrow, executive director of National Advocates for Pregnant Women.
Whether and how a person's marijuana use during pregnancy impacts their developing fetus is still largely unknown, according to Jamila Perritt, president and chief executive of Physicians for Reproductive Health and an OB/GYN. "There's some data out there that sort of looks at risks of preterm delivery, looks at cognitive brain development," she said. "But the tricky part … is that it's hard to pull apart what we call the confounding factors."
Because there's so little information available on the effects of marijuana during pregnancy, Perritt and other doctors often recommend that their patients come off the drugs during pregnancy. In pregnant women, some studies have found, marijuana use can affect the developing fetus's brain and is linked to lower birth weight. The American College of Obstetricians and Gynecologists recommends "that women who are pregnant, planning to get pregnant, or breastfeeding not use marijuana" because "research is limited on the harms of marijuana use for a pregnant woman and her fetus." And according to the Centers for Disease Control and Prevention, using marijuana during pregnancy "may increase your baby's risk of developmental problems" and recommends against it.
Ridgell said she began using medical marijuana when it was legalized in Arizona in 2010 to treat her irritable bowel syndrome. When she found out she was pregnant in the fall of 2018, she talked to her OB/GYN, who already knew she used medical marijuana, and they agreed that Ridgell would try to wean off it. But as she lowered her dose, Ridgell said, she began vomiting daily.
"I just could not keep food down," Ridgell said. "I was so, so sick."
Hyperemesis gravidarum, or HG, is a condition scientists believe may be caused by the rapid rise of hormone levels during pregnancy. Although it occurs in fewer than 2% of pregnancies, people who experience HG may vomit more than four times a day, lose 5% of their body weight, become dehydrated to the point of requiring IV fluids and possibly miscarry.
Ridgell tried anti-nausea medications that her OB/GYN prescribed, she said, but when none helped, she went back to medical marijuana.
When Silas was born, he was taken to the NICU for difficulty breathing and diagnosed with strep throat and bleeding in his brain. There, a doctor ordered a substance exposure test, citing Silas's "jitteriness." When Silas's drug test came back positive for Buspar - Ridgell's anti-anxiety medication - Benadryl and marijuana, a hospital social worker called the Department of Child Safety, according to Ridgell.
According to experts, the consequences of marijuana use can be unequal: People with lower incomes and people of color are more likely to be tested for substance abuse during pregnancy, Perritt said. In 2018, for example, the Administration for Children's Services (ACS) in New York City filed a neglect petition against a Black mother named Shakira Kennedy who also used marijuana to treat her extreme nausea during pregnancy. "When my twins were born, the hospital drug-tested me without telling me," Kennedy told the New York State Assembly a few months later. "They found marijuana in my system, but not in my children. Still, the hospital called ACS."
In 2013, Paltrow and her colleague, Jeanne Flavin, published a study on incidents of arrest or forced interventions on pregnant women in the United States between 1973, the year Roe v. Wade was decided, and 2005. They identified 413 cases, most of which involved people of color or those with low incomes, Paltrow said. Eighty-four percent included an allegation that the pregnant person had used an illegal drug. Those cases took off in the 1980s and '90s during the "crack epidemic," when the media began spreading fears that the predominantly Black children of cocaine-addicted mothers would develop into criminals.
Ridgell's case has been somewhat of an anomaly: As a case manager for Arizona's Department of Child Safety herself, Ridgell, who is White, refused in-home services. She then received an email saying that her case had been substantiated for neglect and that she was fired from her job, she said. Ridgell appealed the department's decision, and in February 2020, an administrative law judge sided with her, finding that most of DCS's evidence "was not the kind of evidence on which a reasonable person would rely." However, a judicial review of the case in Maricopa County Superior Court upheld the DCS decision. DCS declined to comment due to Ridgell's pending appeal.
When Julie Gunnigle, director of politics and civil engagement at Arizona NORML, an organization focused on reforming Arizona's marijuana laws, heard about Ridgell's case, she said she immediately wanted to help and filed Ridgell's appeal pro bono. With her name on the Central Registry, Ridgell can no longer do the social work she's trained for and is instead making $5 an hour less working in medical records, she said. In July, National Advocates for Pregnant Women filed an amicus brief in support of Ridgell's case on behalf of 45 health organizations, doctors and advocates, including comedian Amy Schumer - who herself suffered from HG during her pregnancy.
Since Ridgell came forward, Gunnigle says she's been approached by dozens of families in the same position, many of whom did not have the resources to challenge the decisions in their cases.
One of those women is Jennifer Morris, 32. A White mother of four living in the Phoenix area, Morris works two jobs and began using medical marijuana for pain management six years ago, she said, because she preferred the idea of it to opioid painkillers like vicodin. She'd mentioned that she was a medical marijuana patient to her OB/GYN, but Morris said her doctor never talked to her about her marijuana use or trying to come off it when she got pregnant. When her daughter was born in February 2020, the hospital drug-tested both of them.
The results came back positive, but Morris said she didn't hear from DCS for three months, at which point they asked her to submit to random drug-testing and enroll in an outpatient drug counseling program. Her name was also placed on the child abuse registry, she said, and she feared that she could lose custody of her other children. (DCS declined to comment on Morris's case.)
Arizona's child welfare law is just one of several state laws across the country that have generated controversy. Another is Alabama's chemical endangerment law, which would punish anyone who took a child to an unsafe environment, like a meth lab. But in 2013, that law was interpreted to include fetuses. That year, the Etowah County, Ala., sheriff's office explained that it was "drawing a line in the sand." "If a baby is born with a controlled substance dependency, the mother is going to jail," Sheriff Todd Entrekin said.
Since then, Alabama has prosecuted several mothers who used marijuana during their pregnancies, including one who used it to treat her epilepsy. (Alabama did not legalize medical marijuana until this year.)
Many "of these policies and practices for criminalizing reproduction and the behavior of people with reproductive potential have also been used to dissolve and separate families," Perritt said. She notes that Black and Brown parents are reported to the criminal legal system and have their parental rights terminated at higher rates than their White peers.
While she waits to hear the outcome of her case, Ridgell has been watching her baby boy grow up: Silas is now 2.
"I have been contacted by so many other moms who went through the same thing, or are currently pregnant and struggling and don't know what to do," Ridgell said.
Whatever happens in her case, Ridgell said, she's hoping for a future where she can take the knowledge she gained working for DCS and help other families navigate the child welfare system.
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This story first appeared in The Washington Post's The Lily publication.