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Treating Pregnant Women in Recovery Back to Course Index

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Chemically dependent pregnant and postpartum women not only face the shame of their own unhealthy choices but the guilt of inflicting the damage of addiction on their children. What treatments have helped?

 

TREATING PREGNANT WOMEN IN RECOVERY

 

 

The number of women who are suffering from alcohol or drug addiction while pregnant is growing. Addiction during pregnancy can occur because the mother was already addicted prior to the pregnancy or due to certain factors like stress, life problems, lifestyle and more. Treatment is critical. This is not just harmful and dangerous for the mother’s health and overall well being, but for the developing baby, as well.

 

SUBSTANCES COMMONLY ASSOCIATED WTIH USE DURING PREGNANCY

According to a study by SAMHSA 11.6% of pregnant women aged 15 to 44 years old used alcohol, while 17.3% used tobacco, 6% used prescription medications, and 4.3% used illicit drugs. preg5

A recent study has shown the use of alcohol has recently decreased leaving approximately 40% of the women who are treated during pregnancy dependent on opioids—mostly prescription Vicodin and Oxycontin. There has been a recent uptick of use of IV heroin. Approximately 30-33%, alcohol at about 30% and benzodiazepines, marijuana, and poly-substance abuse. 

 

RISKS ASSOCIATED WITH USE DURING PREGNANCY

These types of prohibited drugs may have a huge negative impact on the health of the mother and also to the unborn child. The drug components can be transmitted to the baby’s blood while in the mother’s womb, and the baby may suffer from different types of abnormalities and defects.

A mother who is taking drugs while pregnant may suffer from:

  • high blood pressure
  • lack of self confidence
  • reduced weight
  • early labor
  • sexually transmitted disease
  • HIV or AIDS
  • premature labor
  • anxiety and depression
  • anemic disorders
  • skin infection

The baby, on the other hand, may experience complications like:

  • stunted growth
  • HIV or AIDS
  • birth defects
  • low birth weight
  • prematurity
  • learning disorders
  • infection
  • trembling
  • addiction
  • sudden death

preg7These are just some of the complications an unborn child and women with drug addiction can experience. Nonetheless, other forms of extreme and life threatening complications may also arise, depending on the severity of the addiction of the mother.

Risks include premature delivery, low birth weight, neurological and congenital problems, increased chance of SIDS (sudden infant death syndrome), developmental delays, higher likelihood for neglect or abuse, as well as mental health and substance abuse problems as the children age.

 

BARRIERS TO TREATMENT

Pregnant women face additional barriers to substance abuse treatment than the average user. Many need intensive treatment, but few treatment programs provide the necessary programs and aftercare. Many traditional residential programs don’t want the liability of treating pregnant women. Pregnant women face increased societal stigma, fear they will lose custody of their children, lack access to gender-specific treatment, lack insurance coverage for aftercare, and lack childcare and/or transportation.

The National Survey of Substance Abuse Treatment Services (N-SSATS) reported that of the 13,720 substance abuse treatment facilities in the US, only 12.7% were programs for pregnant or postpartum women  12.7% of these were programs for pregnant or postpartum women, and a mere 3.9% had residential beds for their clients’ children.

One of the most discussed obstacles is criminalizing drug usepreg6 instead of treating it as a medical disorder. There are statutes in states, Tennessee for example, that would charge a woman with aggravated assault if she tests positive for drugs during her pregnancy. Most doctors agree that this is a health issue—and one of primary concern for pregnant women, most of whom don’t have access to comprehensive drug and prenatal treatment; the quick reaction to punishing women is not the answer.

The best way to address this problem is to have better and more access to treatment. 

Another challenge is the fragmented nature of the insurance system, which both refuses to pay for certain necessary aspects of treatment and cuts funding for aftercare.

Research has shown that providing comprehensive drug treatment and prenatal care for mother and child significantly improves birth outcomes and the child’s development. Contrary to what some believe, pregnant women who are dependent on substances of abuse can deliver healthy babies.

 

TREATMENT

 Studies show that if a woman is able to stop using drugs early during the first term of her pregnancy, there may be a good chance for her to deliver a healthy and unharmed baby. preg1Therefore, women who are pregnant and suffering from drug or alcohol addiction should seek help immediately, in order to save themselves and their baby from sure harm, and start living a normal life while giving the proper prenatal care for their child.

Individualized Treatment and Flexibility
An individualized program and flexibility are among the top recommendations by professionals for treating pregnant or postpartum women addicted to alcohol or other drugs.

The length of treatment at each facility varies based on a woman’s particular needs, her financial and insurance situation, community and family support and strong after care availability.

 “Some women need more than five or six months of residential treatment, particularly if there are psychiatric issues, child-related issues that have not been resolved, or perhaps linkages with community organizations and services have taken more time to set up than anticipated,” says Priscilla Wilson, LISW, NCACII, clinical services supervisor at The Phoenix Center.

A program can be adapted for an expectant mother’s physical symptoms. If her ankles are swollen, she’s nauseated, or she needs to nap, some facilities will allow her to lie down during group sessions, while others will arrange for counseling to take place in her room or will bring her up-to-date later on information that was presented at a lecture that she missed.

Although exceptions are made on a case-by-case basis according to an individual’s health and proximity to childbirth, pregnant and postpartum patients are generally kept busy, and flexibility is not to be abused. Many women experience fatigue, body aches, and nausea during pregnancy.  In the real world, pregnancy does not exclude an expectant mother from day-to-day life or participation in addiction treatment.

Education and Life Skills
Life skills should be taught and practiced regularly in programs. Patients can and should cook, clean, manage the “household” (or living space), and complete other chores. For postpartum patients, of course, caring for baby takes precedence over other activities.PREG8

Education is a large part of treatment in all of the programs for pregnant or postpartum women with addictions and, depending on the facility, can run the gamut from instruction on prenatal and postnatal care, child development, and fetal alcohol syndrome to smoking cessation, sexually transmitted diseases, HIV, and hepatitis C. At Gratitude House, a social worker from the county jail regularly offers presentations that ease patients’ minds by portraying members of law enforcement as friends rather than foes. As would be expected, all of the facilities either use staff or bring in outside agencies to teach parenting classes and instruct patients regarding nurturing a baby.

A special concern is the fact that pregnant women should not take certain psychotropic and other medications.

Treatment Models
A myriad of specialty groups including those for body issues as well as those for grief and loss, forgiveness, and families can be offered. 

Most programs offer dual-diagnosis treatment.  This addresses a patient’s mental illness or other mental health conditions in addition to her substance abuse.

To attend to a pregnant or postpartum patient’s medical concerns, most facilities keep some type of medical personnel—physicians or nurses—on staff.

Experts also stress that those providing counseling and administering treatment be nonjudgmental, especially because women who are addicted and pregnant face severe social stigma. Castellini notes that a single, pregnant woman who has previously lost a child to the child welfare system can be marginalized and regarded as a difficult patient.

Avalanche of Emotions
Psychosocial issues among pregnant women with addiction can be compounded and include guilt, remorse, shame, embarrassment, denial, anger, and loneliness. There’s fear not only that the baby will be born addicted or with other physical or mental challenges caused by drug abuse but also a fear of authorities, being arrested, dealing with the legal system, and basics such as health insurance and employability. 

Just the thought of carrying another living being inside one’s body can be mind boggling and create anxiety-producing for any first-time mother, let alone one who, as a substance abuser, has been running away and covering up emotions and is now battling the urge to use the numbing substance on which she previously relied. Therefore, peer support is essential—more specifically, coming into being as a woman and bonding with other women by talking about the awesome abilities of the female body and the amazing gifts that women experience in conception, pregnancy, and childbirth.

Developing relationships with other women is part of what’s known as gender-specific treatment, or treatment specifically designed for women and their special issues.  Seeing that “I am not the only one” allows women to focus on relationships because women’s lives revolve around relationships, and women recover within their context.

Many women in addiction have no role model for parenting because their mothers were addicted. In addition, “Ninety percent of drug-using women have had violence in their backgrounds,” says Chasnoff, author of The Mystery of Risk: Drugs, Alcohol, Pregnancy, and the Vulnerable Child.

Gender-specific treatment addresses violence while focusing on a woman’s family history, her early childhood attachments, and her current relationships with other adults. Maternal-fetal attachment therapy, which includes tactics such as teaching a mother to read to her baby before it’s born, is employed to help a mother form a bond with her baby.

Also essential to women who are addicted and pregnant or postpartum are aftercare and a connection to community resources, such as prenatal or postnatal services, 12-step programs, and housing, education, and employment services.

 

SUMMARY

PREG9Addiction during pregnancy is a serious problem. Women who are pregnant should be educated and treated, and not isolated or left out. They need help, and help starts within the family and through those that can empathize and care for her. Without the support the battle of conquering her addiction will definitely be hard for her.  There are treatment programs specific to women that also treat pregnant women. Entering treatment can save the life of the mother and baby.