Opioid Addiction in Pregnancy: Ending the Stigma

On Friday, May 8th 2015, I attended Pine Rest’s Annual Perinatal Mood Disorders Conference in Grand Rapids. The topic was “Perinatal Substance Use and the Journey to Wellness.” I learned so much and want to share some reflections on a subject so near and dear to my heart.

The first time I taught childbirth education classes was to the pregnant inmates at the Rose M. Singer Center, A.K.A. Rosie’s, on Riker’s Island, the largest penal colony in the world. There were so many pregnant and postpartum inmates at Rosie’s that they had their own unit. There were two reasons for their high numbers. First of all, New York State, unlike Michigan, has laws that require correctional facilities to accommodate newborns. So long as the mom doesn’t have a conviction that involves harming a child, she can apply to keep her infant with her for one year (or 18 mo., if she will be released within that time) or bring her breastfeeding infant with her during her incarceration. Studies done at Bedford Hills Correctional Facility, which houses one of the oldest prison nurseries in the country, show that there are no harmful effects on the children. Many of the women at Rosie’s are either already participating in or planning to be a part of their on-site nursery.

The second reason has to do with opiate addiction. Riker’s, a jail, housed a methadone treatment program. Withdrawing from opiates during pregnancy can be deadly for both the mother and the fetus, so opiate-dependent women who would otherwise be transferred to a prison to serve a longer sentence remained at Riker’s during their pregnancy to receive methadone maintenance. (At the time I taught there, methadone was the drug of choice for the treatment of opioid addiction during pregnancy. Since other treatments are now available, this may no longer be the case).

There is so much stigma surrounding moms who use during pregnancy, making it even less likely that these women will seek help. Many people believe that a mom who is addicted to an opiate should stop using during pregnancy. Discontinuing opiates during pregnancy is not the standard of care. One of the speakers at the conference, Dr. James Nocon who is both an obstetrician and an attorney, had this to say about providers who encourage women to withdraw during pregnancy, “In my retirement, I want to sue doctors whose patients suffer negative outcomes because they receive improper treatment during pregnancy.” He can be contacted at jnocon@me.com.

My heart breaks every time I hear someone say an infant is “born addicted.” Addiction, by definition, is continuing to use a substance (or repeat a process) despite negative consequences. An infant can be born dependent, but cannot be an addict. I know that many people have personal experiences caring for the children of parents who could not themselves care for them due to substance abuse disorders, resulting in strong emotions. However, vilifying parents with addictions will not help these children. As a Certified Substance Abuse Prevention Specialist, I know that if we want to help infants and children, we need to look at the underlying causes of why women use. The vast majority of women who use during pregnancy are self-medicating due to the effects of trauma and abuse. This is true whether the substance is cigarettes, alcohol, crack or heroin.

If we are truly dedicated to helping children prenatally exposed to substances, we should focus not just on treatment, but prevention. Gender-based violence is the result of oppression, which stems from inequality. When we fight for gender equality (e.g. pay equity, paid parental leave, paid sick time, LGBTQ rights, etc.), we are working to elevate the status of women and end the trauma of abuse.

Developed by Larry Cohen, based on the work of Dr. Marshall Swift.  Available at: http://home.preventioninstitute.org/tool_spectrum.html

Developed by Larry Cohen, based on the work of Dr. Marshall Swift. Available at: http://home.preventioninstitute.org/tool_spectrum.html

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