When a woman discovers she is pregnant, it should be a time of joy and excitement. Being a part of bringing a new life into this world is an unforgettable experience. No parent wants to harm his or her child, and so pregnant mothers have many worries on their minds to provide the best for their children.
When an expectant mother has an addiction or a substance abuse problem, these worries are even more serious. Even though the mother may want to quit, and be trying to quit, the period of withdrawal can be stressful for her, and even harmful for the baby.
Obviously, the main concern in this situation is the impact that using drugs and alcohol will have on the unborn child. Pregnant women know that whatever goes into the mother’s body will find its way into the fetus. If the mother uses and gets high, so does the baby.
The difference is that because the baby is so much smaller, and is developing rapidly, especially through the first months of pregnancy, the effects of any drugs or alcohol on the child are greater. Unfortunately, the barriers of shame and social stigma sometimes hold back a mother from reaching out to receive the care that she and her baby need.
There is hope; through working with health professionals, an expectant mother can receive help in overcoming her own addictions, as well as get assistance to make sure that her baby has a chance to not only survive but thrive. Here are some things you may or may not know about pregnancy and addiction.
There is an entire panel of substances that can be checked by doctors during the meconium screenings. If the hospital completes the whole battery of tests, there are thirteen categories that are tested.
There are what are considered recreational drugs which include cannabinoids (marijuana) and phencyclidine (PCP or angel dust). These drugs are less likely to be used on a frequent basis by mothers because they're less addictive than other substances.
Prescription medications that get abused with legal prescritptions or illegally. these types of drugs include amphetamines (methamphetamines, ecstasy, and things like legal and more common ADHD medications), barbiturates (sometimes used for anxiety), benzodiazepines (in some sleep medications; less toxic than barbiturates but also are known to cause withdrawal in newborn babies) , propoxyphene, oxycodone, meperidine, and tramadol (all four are painkillers also in the opiate family).
The illegal recreational or lifestyle drugs include crack/cocaine, opiates (heroin and morphine), methadone (an opioid used to help with detoxification when refraining from illegal drug use), The test results are usually returned to the hospital on the same day they are sent to the laboratories.
It would surprise most women to hear that there are pregnant women who continue to use drugs and drink alcohol during their pregnancy. Usually pregnancy is the time to quit bad habits, but some women's addictions are too tough to break even for nine months.
To better understand just how big of a problem substance abuse during pregnancy is, consider the following statistics from the United States Drug Testing Laboratories. Their studies show that teenage pregnant women (15-17 years old) are more likely to continue to use drugs at higher rates than their older counterparts, more than double the rate.
Alcohol use during pregnancy was another issue found in the research. Out of those women who were pregnant and admitted that they consumed alcohol during the pregnancy, about 10 percent said that they were regularly drinking while pregnant - i.e. it wasn't a one-time thing.
Almost 4 percent admitted to binge drinking large amounts of alcohol at one time. One in ten of the women said that they had binge drank during the first trimester of the pregnancy.
Doctors and nurses who work on a hospital staff know the prevalence of substance abuse during pregnancy, particularly those who work in the NICU (Neonatal Intensive Care Unit), others may not have experience or knowledge of this issue.
Even if a doctor or midwife has known a patient for years, even if the current pregnancy is not the patient’s first, every expectant mother will probably be asked at every appointment if they have been using drugs and alcohol. It is common practice – and it doesn’t mean a particular person is being singled out or judged for any specific reason.
Drug and alcohol abuse can be observed in every economic circle, in someone of any religion or ethnic background. The medical professionals want to help every pregnancy be as healthy as possible. Every parent wishes for the best possible well-being for his or her baby; this is just another aspect of prenatal care, along with taking prenatal vitamins and ultrasounds. (And on that note, see the next point – it’s best to be honest!)
Some mothers may have used illegal substances or partook in alcohol before they knew they were pregnant. Some are struggling with addiction and found it difficult to quit using a substance – even after they knew they were pregnant. As hard as it may be to admit such things even to a doctor, it is imperative that this knowledge is shared during prenatal visits.
Once the doctor knows about any of these substances being used in a pregnancy, a plan can be created. Help can be given to assist in the withdrawing from using. The baby’s health can be evaluated even more specifically, with options in place in case the pregnancy starts showing negative effects of the substance abuse. A pregnant mother’s birth team needs to have as much information as possible in order to provide the best care!
In some cases, such as in heroin and other opiate use, it can be more stressful to the mother to quit a drug immediately – and even harmful to the baby. Methadone is used in these situations to help the mother refrain from using the most damaging substances while still ensuring that the body doesn’t experience severe withdrawal symptoms.
Methadone is a prescription given by a trained doctor, and under that doctor’s strict observation. It is an opioid and not an opiate, in other words, similar enough to trick the body into thinking it is receiving something to soothe the addiction, but with less harmful effects. The goal would be to lessen the dosage and frequency as the pregnancy goes along, to wean both bodies off of the substances.
This treatment would be used along with counseling, vigilant prenatal care, and nutritional education to ensure the best possible outcome for both mother and baby. The American College of Obstetricians and Gynecologists caution on its website, “Concern about a potential small increased risk of birth defects associated with opioid-assisted therapy during pregnancy must be weighed against the clear risks associated with the ongoing use of illicit opioids by a pregnant woman.”
A baby’s meconium (a baby’s first bowel movement, that black, tar-like substance that appears within a few days after birth) is tested by hospital professionals after virtually every delivery. Unlike baby’s feces that appear later, meconium contains materials ingested by the baby from the mother’s body during the pregnancy.
While hospitals can also test blood and urine, or even hair or fingernails – of both the mother and baby – the fact that meconium is formed from everything that went through the baby’s system makes it an ideal place to look to determine which substances were exposed to the baby in utero.
Testing meconium can determine exposure levels back for weeks prior to the birth – in some cases, even up to half of the length of the pregnancy. The doctors do not need permission to perform these tests.
These screenings taken at the hospital reveal the amount of varying substances found in the baby’s system at the time of birth. The tests cannot tell how much the mother used at one time, or how often she used, or when she used. Too many variables exist to be able to pinpoint those details. If a substance is found in meconium, it could have been there for up to twenty weeks – half of the pregnancy.
The mother’s fingernails or hair could give a more accurate portrayal of any drug use in the past several days, but that won’t tell if she has been a chronic user. Obviously, tests of the baby's meconium cannot show anything about the father's drug or alcohol use, unless of course his hair or fingernails are screened on their own.
Again, every case is different. If an expectant mother has been using drugs or alcohol during a pregnancy and lets a doctor know, that does not necessarily mean that the doctor will give a negative report to CPS. Having the substance use discovered by Child Protective Services does not necessarily mean that the child will be taken away.
If the birth parents are open and honest about the drug use from the beginning, and show their commitment to refrain and make better choices in the future, there are myriads of resources to partner along with families. Medically and emotionally, help can be given to ensure the best possible health of everyone involved.
CPS can and will only remove a child from a home if it is determined that it is absolutely necessary, to protect them from abuse or neglect.
The doctors, nurses, and/or midwives will be looking for various symptoms to be present in a baby experiencing withdrawal from drugs or alcohol. The baby will most likely be experiencing physical pain due to the body’s reactions to having a lesser amount of the substance.
He or she would thus exhibit extensive crying, arching of the back or, alternately, curling up into a ball. Temperatures may fluctuate. The baby may have diarrhea and an upset stomach and experience vomiting, making him or her not interested in eating. Mottling of the skin with red patches may appear. The baby may have trembling or even seizures.
They may sweat or have trouble sleeping. Every couple of hours, symptoms like these will be evaluated by the staff, which is called “neonatal abstinence syndrome scoring system”. Points will be given to how severely the baby is showing each symptom for a total score. As the points go down, the child’s body is showing less dependence on the substance.
The answer to this question varies based on the substance, the baby, and the hospital staff’s direction. For a baby born who has been exposed to large amounts of alcohol in utero, there is usually no treatment, and no need for a NICU stay. The main concern is that the baby is eating (and pooping!) and not exhibiting the signs of stress that demonstrate withdrawal symptoms.
If a baby has been exposed to amphetamines, a couple of days might ensure that the substance has left the body and the baby can be released. With a substance like heroin, the time will be much longer. Some babies may stay up to two months or more before opiates are completely flushed out of the system and the body is recuperated enough for discharge.
In the NICU, babies born addicted will be kept warm and fed. Their heartbeats and blood pressure will be monitored. Some may have trouble eating if they had any problems with the development of their lungs or hearts; parents, along with the attending nurses and doctors, may need special feeding techniques to ensure that the baby gets adequate nutrition.
They may need extra vitamins or even medications in some cases. Babies with the worst addictions will be often given morphine to combat the pain they feel while their bodies are detoxifying the drugs from their systems. If the symptoms mentioned above seem to be stabilizing, the level of morphine will go down on the next dose.
If the symptoms are the same or worsening, the next dose may be the same or even increased back up to a previous level if needed. The challenge is to wean the baby off of the morphine as quickly as possible, while introducing the lowest level of stress onto the baby’s system.
The biggest task for the health care professionals who are providing care is the baby’s immediate health. Using drugs and alcohol during pregnancy can cause pregnancy complications, birth defects, premature birth, low birth weight, or even stillborn birth. By utilizing ultrasounds and other prenatal tests, the parents and birth team can be made aware of any existing complications and better prepare for the birth.
A specific birth plan can be put into place to deal with any situation that may arise. After the baby is born, other tests can be given to find out if there are any additional concerns. The plan of action really will depend on which substances entered into the baby’s system, and how severely the baby has been affected. Once again, having the greatest amount of information possible will give the baby the best chance for success.
Once the pressing concerns of immediate physical health have been addressed, and the withdrawal period has passed, the baby can most often be allowed to go home. Sometimes, thankfully, there will be no further effects on the child. For other children, however, there may be life-long issues to face.
Using these harmful substances during a pregnancy may lead to behavioral problems in children. They may have emotional issues and learning disabilities. If he or she was born with physical impairments, that will be something to continually overcome and for parents to learn how to assist the child with.
Speech, physical, or occupational therapies may be needed, if even for a short time. Working with the child’s pediatrician, therapists, and any mental health professionals can be an important element of providing for the best possible outcome for the future considering the baby's circumstances.
Up to 30 percent of women admit they drank at least some alcohol during their pregnancy. Since there is no way to measure what is a "safe" amount of alcohol to consume while you're pregnant, most obstetricians advise their patients to completely abstain. Between 2 percent and 5 percent of children are born every year who are diagnosed with Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effect (FAE).
A child whose mother drank heavily during the pregnancy may have an abnormal appearance, may be short in height, have low body weight or a small head size. He or she may show poor coordination, low intelligence, behavior problems, and issues hearing and seeing.
While there is currently no treatment for fetal alcohol syndrome and fetal alcohol effect, early diagnosis of these syndromes allow newborns to be identified and enrolled into early intervention and treatment programs.
Absolutely, yes! Nobody will tell a person with an addiction issue that the road to recovery is going to be easy. When pregnancy is added to the equation, the process may seem doubly difficult. However, with open communication between the mother, the birth team, and the child's pediatrician, a potentially bad situation can be made better.
An open and honest relationship with treating physicians means that the mother and baby will receive the best care and treatment to help both mother and child through the process so no one is hurt or put in danger.
Obtaining help will make sure that the child is born - and stays - healthy, and that a relapse back into addiction is less likely to happen. For someone who is determined to make a change, situations can be turned around.
Special note: If you or someone you know is dealing with addiction issues, get help today by calling (877) 671-1785.