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Drug and alcohol use during pregnancy is not only harmful to the unborn baby but also to the mother. The National Institute on Drug Abuse (NIDA) warns that substance abuse while pregnant may result in miscarriage, stillbirth, infant withdrawal syndrome, birth defects, premature birth, low birth weights, and sudden infant death syndrome (SIDS).
Addiction can be a complex disease, requiring professional help and treatment to help attain, and sustain, complete sobriety. The National Survey on Drug Use and Health (NSDUH) reports that between 2012 and 2013, approximately 9.4 percent of pregnant women between the ages of 15 and 44 were classified as current alcohol drinkers and 5.4 percent used illicit drugs. No amount of drug or alcohol abuse is considered to be safe during pregnancy. A specialized addiction treatment program can help pregnant women to safely stop using drugs and/or alcohol while supporting them in recovery and attending to their medical needs.
Examples of addiction treatment services offered to pregnant women include:
As of 2010, the American College of Obstetricians and Gynecologists (ACOG) publishes that only 19 states have addiction treatment programs designed specifically to treat pregnant women. Women may fear legal troubles or the loss of their child as a result of seeking care. Oftentimes, substance abuse treatment services are mandated by the criminal justice system when women are known to be abusing drugs while pregnant. Women should be encouraged to seek addiction treatment to better themselves and to promote a healthy pregnancy.
Treatment facilities that understand the plights of pregnant women can work with families and individuals to set a strong foundation for recovery. Pregnant women have unique treatment needs, and specialized addiction treatment facilities with specific programs designed to help these women stop using harmful substances and develop healthy life skills while providing encouragement and supportive care for both mom and baby are highly beneficial in recovery.
With drug and alcohol addiction often comes physical dependence, meaning that if these substances are stopped suddenly, difficult and even potentially life-threatening withdrawal symptoms may ensue. The baby can be put at risk; with opioid dependence, preterm labor, fetal distress, and even fetal death can occur if these drugs are stopped “cold turkey” after dependence has formed, ACOG warns. For this reason, even when pregnant, individuals battling addiction are not encouraged to suddenly stop taking drugs or drinking alcohol on their own without professional help. Medical detox provides the safest environment and care for pregnant women as they work to stop taking harmful substances.
Pregnancy alters a woman’s body chemistry and metabolism and can therefore impact withdrawal timelines. The intensity and duration of withdrawal also depend on how long a person has been using drugs; the type, amount, and method of drug abused; and several other biological, environmental, and genetic factors. The New York State Office of Alcoholism and Substance Abuse Services (NY OASAS) publishes the following general timelines for the onset of maternal withdrawal symptoms:
There are currently no FDA-approved medications to treat opioid, or other drug, dependence in pregnant women specifically, NIDA reports; however, replacement medications with low risk factors are often beneficial during detox. For example, both methadone and buprenorphine are long-acting opioid drugs that are frequently used to replace shorter-acting opioids like heroin or prescription painkillers during detox. These medications do still carry the risk of the infant developing neonatal abstinence syndrome (NAS) at birth; however, symptoms are typically fewer and less severe than those related to heroin.
Benzodiazepine medications are often used in the treatment of withdrawal from alcohol, and long-acting benzodiazepines may be substituted for shorter-acting ones during detox. Typically, these substances are tapered off slowly to minimize the possible withdrawal symptoms, and often, adjunct medications are beneficial as well. Medical professionals work directly with pregnant women to help them understand the risks of medications and withdrawal symptoms, and to find a healthy middle ground. Medical detox can help pregnant women to become physically stable before moving on into a complete addiction treatment program.
Detox is not addiction treatment on its own; rather, it’s the first step in a complete addiction treatment program. After detox, individuals should enter into a specialized treatment program. Generally speaking, a residential treatment plan wherein a person can stay in a specialized facility to receive care and supervision 24 hours a day, seven days a week, is preferable and considered to be the optimal level of care for pregnant women. These programs may also offer services for women after the baby is born, including housing and childcare options.
Outpatient programs may be more flexible, especially for women with other children or those who need to continue to work or attend school. In an outpatient addiction treatment program, women attend meetings and sessions during the day and/or evening and go home each night. Childcare and transportation services may be offered. A strong and supportive home environment is imperative for outpatient care.
No matter which type of treatment program is ultimately chosen, NIDA recommends a treatment duration of at least 90 days. Treatment programs for pregnant women may be offered by the state or federal government (public programs open to any eligible person) or privately funded. It may be more difficult to find space in public treatment programs, and private rehab is often able to offer a wider range of services and amenities.
While participating in an addiction treatment program, women can receive obstetric care, prenatal checkups, and any necessary medical treatment, which is vital to a healthy pregnancy. Nutritional services, healthy diet plans, and structured sleep schedules are maintained in residential addiction treatment programs, which serve to improve the health of both the mother and unborn baby.
Mental healthcare is also an integral aspect during addiction treatment, and this includes both individual and group therapy sessions. Group sessions may take place with other pregnant women and focus on specific issues for this population. Women can work together during group skills sessions to learn parenting techniques and healthy stress coping mechanisms. Behavioral therapies delve into what may have led to the abuse of drugs in the first place, and they can help women to learn new ways of thinking that will support healthy behaviors and habits going forward. Women may also benefit from counseling on how to handle childbirth, pain, and medical concerns that can arise both during pregnancy and in childbirth and set up a plan that will work in tandem with addiction treatment. For instance, pain medications may need to be closely monitored or substituted for non-habit-forming ones following childbirth.
Peer support groups for pregnant women provide encouragement and mental strength for maintaining long-term abstinence. Groups often exist that are specifically designed to foster a healthy social and peer network for pregnant women who struggle with addiction. These groups can provide emotional support and understanding from others in similar situations. Transitional programs and aftercare services can offer educational programs, vocational training, relapse prevention programs, childcare services, and housing options for women and their newborns to support a sustained recovery as well.
Women face many possible complications during pregnancy and childbirth that may require medical care, pharmacological tools, and mental health support. When addiction is added to the mix, it is beneficial for all treatment providers to work together to devise and implement a comprehensive care plan. Treatment programs for pregnant women battling addiction are highly specialized and aim to help women through their pregnancy and childbirth while fostering long-term recovery.