Inaccurate ideas and discriminatory policies toward pregnant substance users create barriers to appropriate care. One local center is stepping up to the plate.

“She deserves to spend the rest of her life in jail.” “Monster.” “Addict.” “Junkie.” “She deserves to have her children taken away from her.” “Why do those people even have kids?”

You might hear any of these statements after the latest news item comes out about a mother arrested for using substances while pregnant. They’re pretty common and predictable reactions. And they unfortunately normalize an increasing tendency to criminalize pregnant women with substance use disorders.

But condemnation of pregnant women who use substances—in the form of social attitudes or public policies—has profound, largely needless consequences. For example:

  • The resulting prejudice can prevent a pregnant woman with substance issues from seeking any prenatal care
  • Incarceration separates mothers from their children, fragments families, and increases the prison population unnecessarily

The reality of addressing substance use among pregnant women is a lot more complicated than “she deserves to spend the rest of her life in jail.”

The media has helped make pregnant substance users objects of social disgust

The media is a key driver of social attitudes toward drug use and pregnancy and since the 1980s has painted pregnant women with SUDs as selfish and immoral.

To expose a pattern of these depictions, 51 doctors composed an open letter to the media in which they collected headlines from various major and local news outlets that inaccurately report newborns as “addicted” to drugs at birth in a bid to tug at the heartstrings of viewers and promote outrage.

But the headlines don’t differentiate between physiological dependence on opioids–a condition known as neonatal abstinence syndrome (NAS), which is treatable and not permanent–and psychological compulsion, which has never been proven to exist in infants.

Other major news outlets, such as NBC and ABC News, are also guilty of making explicit connections between infants born with NAS to mothers with opiate use disorders and the generation of “crack babies” of the 1980s, an “epidemic” that has since been disproven by researchers.

This video of Dr. Deborah A. Frank explains why buying in to drug use prejudice is dangerous for women and children.

Real women are affected by these portrayals

The women impacted by discriminatory policies are often among the most vulnerable in our society: minority women, women of lower socio-economic status, and women who have histories of trauma and abuse. For many of these women, access to medical care, education, transportation, parenting support, and child care is restricted.

In 2010, Kristian McManus was charged in South Carolina with unlawful conduct toward a child, a charge carrying 10 years imprisonment, for having opiates and benzodiazepines in her system while delivering her baby. In rural Alabama, Amanda Kimbrough’s daughters were taken away from her after she delivered her son prematurely and tested positive for methamphetamines in 2008. After her son died, she was charged with a Class A felony and sentenced to a minimum of 10 years. Over 60 women have been charged similarly in Alabama since 2006.

Especially troubling is the criminalization of those on maintenance therapies for opiate use disorders, like methadone or buprenorphine, even though this treatment is indicated as a best practice by the American College of Obstetricians and Gynecologists. And perhaps even more worrisome is the 2013 criminalization of Alicia Beltran who refused buprenorphine treatment because she was already in recovery and clear of opiates; her provider reported her to the authorities in Wisconsin and she was arrested while still pregnant. Similarly, Tamara Loertscher was arrested this year and jailed for refusing to attend an inpatient program for substance use. She had used marijuana and methamphetamines to self-medicate a thyroid condition and depression, but stopped once she discovered she was pregnant. In jail, she received no prenatal care.

In spite of expert opposition, legislation criminalizing pregnant substance users continues to be passed

Many health care providers oppose policies that criminalize women with SUDs because they prevent women from seeking care that they need. Women won’t go to providers for care if they are afraid that they will be judged, arrested, or have their children removed. And care is critical for any pregnant woman, but especially so for one with substance use issues.

But despite the fact that the American College of Obstetricians and Gynecologists roundly stated that “The use of the legal system to address perinatal alcohol and substance abuse is inappropriate,” lawmakers continue to promote the “easy fix” of criminalization. Tennessee’s legislature passed SB 1391 this year  to criminalize any woman whose infant is born “addicted to or harmed by” illicit substances, and the first arrest was made in July of this year.

This is only the latest bill passed in a long line of legislation seeking to criminalize pregnant women since the 1980s furor surrounding the “crack epidemic.”  The Guttmacher Institute reports that as of November 2014, substance use during pregnancy is officially considered child abuse in 18 states, and is grounds for civil commitment in Minnesota, South Dakota, and Wisconsin.

One local answer to the need for comprehensive care for pregnant women dependent on opioids

The good news is that 19 states have earmarked funding for programs specifically targeted at pregnant women. Pennsylvania is one of these states. And other solutions are possible beyond state funding, as a recent alliance of hospitals and insurers in Pittsburgh has proven.

This summer, Magee-Women’s Hospital of UPMC, along with partners Allegheny County Office of Behavioral Health,Community Care Behavioral Health Organization, UPMC for You, Gateway Health, and United Healthcare for Families and Communities, introduced a new program, the Pregnancy Recovery Center (PRC), for pregnant women and new mothers with opioid use disorders.

It’s the first and only buprenorphine clinic to treat pregnant women using the medical home model approach, including obstetric care, behavioral health, and a buprenorphine clinic. Other methadone or buprenorphine clinics require a daily visit to obtain the dose for the first few months of treatment, which can be difficult for patients to get to when they have obstetric appointments, morning sickness, child care issues, and other hindrances associated with being both female and pregnant in our culture–not the least of which is social prejudice.

Rather than making daily trips to receive their medication, patients at the PRC receive once-a-week prescriptions for buprenorphine (approved by ACOG for treatment), which is more convenient for pregnant women who are already overtaxed.  Buprenorphine is also linked with milder occurrences of neonatal abstinence syndrome.

A standardized dose of methadone or buprenorphine reduces the risk of overdose from a non-standard opioid. And standardized, even dosing also prevents withdrawal in mothers, which can be dangerous for the developing fetus. Furthermore, medication-assisted treatment (MAT) provides a safety net for the mother by helping her avoid risky situations associated with obtaining and using illegal drugs. (For more information on this subject, read our post on MAT for pregnant opioid users and neonatal abstinence syndrome.)

MAT also involves behavioral health services to address underlying issues that contribute to SUDs, a important part of long-term recovery. Because part of its mission is to support women’s long-term recovery, the PRC offers weekly counseling to its patients as part of its MAT program. It also connects its patients to buprenorphine providers after delivery for continued care.

But what makes the PRC stand out from other buprenophine or methadone clinics is that it requires prenatal care for all its patients with Magee’s midwives. Magee’s Certified Nurse Midwives specialize in building trusting relationships and offering a safe, nonjudgmental environment for PRC patients, crucial for this population who otherwise might not seek care during their pregnancies.  Delivery care and up to six weeks of aftercare are also offered to all patients.

And the Center provides women with information about resources in the area to support their recovery. For instance, it links patients with programs like Travelers Aid’s Mobile Moms that provides rides to and from appointments for eligible pregnant mothers.

So far, the PRC has seen a range of women, ages 20-43, with gestational ages of anywhere from 6 weeks to 39 weeks—right before birth. Their philosophy is that they don’t want to turn away anyone who needs the help. It’s a good philosophy.

Resources

Magee-Womens Hospital of UPMC

National Advocates for Pregnant Women

World Health Organization. (2014). Guidelines for identification and management of substance use and substance use disorders in pregnancy

Game of Thrones: Protecting Pregnant Patients (2014)

Video: Patient Access to Medications (2013)