While major medical organizations caution against cannabis use during pregnancy due to theoretical neurodevelopmental risks and potential associative links with low birth weight, millions of pregnant individuals experience debilitating nausea, hyperemesis gravidarum, and severe pain unresponsive to conventional therapies. Because ethical constraints prevent randomized controlled trials, available clinical literature relies almost entirely on retrospective observational datasets heavily confounded by polysubstance exposure, socioeconomic stressors, and unverified self-reporting. Board-certified family physician Dr. Benjamin Caplan provides an evidence-grounded review of placental endocannabinoid physiology, methodological study limitations, and compassionate clinical decision-making for patients and healthcare providers.