News

What can be done to erase stigma for expectant moms with substance use disorders

Dealing with drug addiction can be tough enough, but women also can face stigma for being pregnant while taking illegal or even legal medication to address addiction, health officials said.

Local health officials have been working in recent years to reduce that stigma and encourage expectant mothers with substance use issues to confide their drug use to their doctors to help with the health of the mothers and their babies.

Babies are not born addicted, said Lori Sprecher, clinical manager of Meritus Medical Center's special care nursery. Addiction requires a behavior. When babies are born and the umbilical cord is cut, they deal with withdrawal symptoms whether the mother was taking illegal drugs or addiction treatment medication.

Washington County Recovery Oriented Systems of Care, a network of community-based services that support those affected by substance use, is partnering with Washington Goes Purple and the county health department's Baby & Me Tobacco Free program this month — Neonatal Abstinence Syndrome Awareness Month —  to raise awareness of NAS and substance-abused newborns in general. The campaign is focusing on reducing the health-related stigma among moms and babies in hopes the moms reach out for and accept the support and care they need, said Laura Sheffield-Bishop, a social work supervisor with the Washington County Health Department.

To raise awareness, people are asked to wear bowties or pearls — real or not — so others will ask them why they are wearing them, Sheffield-Bishop said. The idea was borrowed from a Knoxville, Tenn., area campaign.

What are substance-abused newborns dealing with?

Neonatal abstinence syndrome, or NAS, "is a treatable condition that newborns may experience as a result of prenatal exposure to certain substances, most often opioids," according to the National Center on Substance Abuse and Child Welfare.

From July 2020 to September 2021, Washington County had 172 substance-exposed newborns, according to Sheffield-Bishop. While the exact number of cases per drug was not available, those substances included marijuana, cocaine, heroin and prescribed medication used to treat opioid addiction.

Sprecher estimated that about 100 of those babies were exposed to opioids and probably 90% of those were addiction treatment drugs like methadone, Subutex or Suboxone.

In the past two to three years, Meritus also has seen a lot of expecting or delivering moms who use marijuana — alone or with another drug, according to Sprecher and neonatal Dr. Theresa Mondoa.

"Social media tout the use of marijuana for severe nausea associated with pregnancy, and its legalization in some areas may give the false impression that it is safe," according to a 2018 American Academy of Pediatrics news release.

Observational studies indicate concerns from fetal growth to long-term neurodevelopmental and behavior issues.

While pregnant women might use marijuana to address nausea, it's not the best medicine for nausea, Sprecher said.

Sometimes Meritus sees moms who have smoked marijuana laced with cocaine.

"Cocaine in itself can be a little bit more dangerous in pregnancy because it can cause preterm labor and abruption, meaning the placenta can come away from the uterus," Sprecher said.

Help for moms and babies

One of the myths related to expecting moms using legal or illicit drugs is their baby will be taken away from them when it's born if the mom tests positive for drugs, health officials said.

It would take "a lot" to lead to social services removing a child from the home, Sprecher said.

Federal law requires the hospital to report substance-exposed newborns to social services, Sprecher said.

But the hospital, social services and health department work as a team to ensure the baby and mom have the services they need, health officials said.

Helping moms starts in their obstetrician offices, where women could be asked if they are using drugs or alcohol and learn about support services, Sprecher said.

If a newborn tests positive for opioids, it stays at the hospital for at least five days to be monitored for withdraw symptoms, Sprecher said. Roughly 25% to 30% of the substance-exposed newborns at Meritus need medication such as morphine to help with opioid withdrawal symptoms that can vary widely.

It's hard to predict which baby will have a harder time with withdrawal, Sprecher said.

There's not a lot of information available yet about the long-term affect on babies withdrawing from opioids such as prescription meds, Sprecher said.

In 2018, Meritus began a program to keep the mom and baby together for those five days instead of having the mom discharged while the baby remained at the hospital.

This allows the mom to learn the baby's cues and how to soothe it. While a nurse might have three or four babies to care for, the mom is right there to respond to the baby, Sprecher said.

Sprecher recalled seeing the anxiety leave an expectant mother when she learned she wouldn't be separated from her child. That's why Meritus tries to talk to expectant mothers before they arrive for delivery, so they understand the process and know what to expect.

During the COVID-19 pandemic there have been times when hospital beds are so full, it was difficult to get a pediatric bed for the mom, but they strive to do so, Sprecher said.

The county health department has recovery coordination for pregnant and postpartum women in which peer-support specialists help moms, getting them linked to services such as food banks to accompanying them to a medical appointment, Sheffield-Bishop said.

A peer-support specialist has gone through their own drug recovery so someone still dealing with substance use disorders or withdrawal might be more willing to listen to them.

The health department also is working with social services on a new START initiative, a sobriety treatment and recovery team to aid high-risk families with a primary diagnosis of substance use, Sheffield-Bishop said.

Evidence from similar programs in Maryland shows the program reduces the chances of child neglect and results in better outcomes for parents and babies, she said.

What can friends, family do?

There's a lot of stigma around pregnant moms with substance abuse disorder, where they feel they are being judged, looked down upon or even receiving a lower quality of care, said Melanie Watts, a peer-support specialist with the health department.

Such feelings could prevent a pregnant woman from wanting any care or cause her to only accept limited care, said Watts, who previously worked in a similar role in Meritus' labor and delivery department.

One thing family and friends can do to help expectant mothers is change their vocabulary when speaking to people suffering from substance abuse disorder, Watts said.

Don't label people as addicts, she said. They have a substance use disorder.

Watts recommends learning about substance use disorders and being supportive for the expectant or new mom.

Also, realize that not everyone's path to recovery is the same. Some people aren't ready yet to accept recovery. 

If they aren't ready for recovery, "support and meet them where they are," Watts said. That could make the expectant mother more likely to show up for medical assistance and other help.

Stigma can be lessened by starting a conversation, said Watts, whose daughter had neonatal abstinence syndrome. Watts said she's "been clean" for five years.

There's even a "big stigma" around using medication-assisted treatment, but it's safer for the mother and baby if the expectant mom is on a regulated dose of a treatment drug than using opioids off the street, Watts said.

Because of Watts' experience, pregnant women with substance use disorders might be more comfortable talking to her than a doctor. If that's the case, Watts said she can serve as the patient's "voice" if they feel they aren't getting quality care.

"I feel like a lot of people who suffer with substance use disorder feel they can't be heard," Watts said.

Sprecher said she's seeing moms become more forthcoming in recent years about substances. They're learning it's safe to to share that information with medical professionals and get support.

Sprecher encourages expectant moms dealing with substance abuse disorder to have someone they can talk to. It can be difficult to explain to loved ones not in the know why the baby has to stay at the hospital for five days, she said.

It's rare for Sprecher to see a mom who doesn't have at least one person they can confide in, she said.

Pregnant women with substance abuse disorders seeking assistance can call Laura Sheffield-Bishop at the health department at 240-313-3398.

This article first published in The Herald-Mail and Herald-Mail Media online in October 2021.