Pregnancy Care in Times of Cannabis Legalization: Self-Rated Knowledge, Risk Perception and Communication Practices of Midwives in Germany

Background/Objectives: The legalization of recreational cannabis in Germany in 2024 has increased the relevance of cannabis use in maternal healthcare. Although prenatal cannabis exposure is associated with potential risks to fetal development, the topic remains underrepresented in midwifery research and education. Germany, midwives play a key role in prenatal care. This study investigates midwives’ self-rated knowledge, perceived risks, and the frequency of screening and counseling on cannabis use during pregnancy. Methods: This study presents a secondary analysis of cross-sectional survey data collected from midwives and physicians in Germany (N = 284) between May and October 2024. Statistical analyses included descriptive statistics, Wilcoxon signed-rank tests, chi-square tests, Spearman’s rank correlations, and multiple linear regression models. Results: Midwives rated their knowledge about cannabis-related risks during pregnancy as moderate. While most reported that substance use was addressed in initial training, only continuing education and older age were associated with higher self-rated knowledge. Knowledge was positively correlated with risk perception and communication frequency. Overall, risk perception was high—particularly regarding fetal outcomes—though cannabis was perceived as less harmful than alcohol and addressed less often. Fewer than half of the midwives routinely screened for cannabis use, and only 22% always provided counseling. Conclusions: To strengthen midwives’ preparedness, both the integration of cannabis-specific content into initial training and the expansion of continuing education may be beneficial. Clear, evidence-based, and non-stigmatizing communication strategies are essential to support maternal and fetal health in a changing legal and cultural landscape.