Protecting Infants, Supporting Mothers

Even a quick scan of the daily news tells the story of the opioid epidemic that causes devastating harm to the substance user, her children and family, and the larger community. You don’t have to look far to find the story of a tragic death from overdose or a report on the harm that Substance Use Disorder (SUD) causes newborn babies exposed to drugs in utero. Everyone but the cruelest would agree that infants should be given the best start possible in life, and that entering the world with Neonatal Abstinence Syndrome (NAS, “withdrawal” in newborns) is nowhere near that mark. And, it’s important to note that NAS exists not only in opioid addiction; withdrawal from alcohol, tobacco, and other drugs also occurs.

One arena in which the issues effecting newborns is a “hot topic” is our state legislature. Recently, Rep. Kathy Watson (R-Bucks County) introduced a bill that would help ensure that babies who are born dependent on controlled substances are safely cared for and receive critical medical and developmental services. The legislation would reverse a 2015 amendment to the state’s Child Protective Services Act that exempted health care providers from reporting infants born exposed to drugs when mothers were legally prescribed addictive narcotics during pregnancy. Clearly, the protection of the newborn is the most crucial of concerns, but that’s not where the concern ends.

Is it possible to care about babies and not their mothers? I don’t think so, and I don’t think it’s an either/or choice. So, how do we do both?

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In an ideal world, there would be readily available treatment for women who would seek help early, surrounded by a loving family to temporarily care for their kids and then provide support as they recover. Treatment would offer services aimed specifically at pregnant and postpartum women. This ideal world would not subject the substance user to the shame and stigma associated with SUD that stops many from asking for help. Women would not have to choose between getting prenatal care and losing their children. And babies would be kept near – not taken away from – their mothers in early recovery.

If only we lived in an ideal world.

In our real world, we often take an almost opposite approach. Less than a quarter of our nation’s SUD treatment centers offer specific services for pregnant and postpartum women, and even fewer offer recovery drugs to control cravings and withdrawal. Experts say that quitting drug use without the use of such medications has a higher incidence of relapse and can be stressful on a fetus, according to a recent article in the Washington Post. And opiate antagonist drugs like Vivitrol® show great promise preventing relapse. We’ve made a lot of progress in offering recovery medications in general, but pregnant women face resistance from doctors wary of harming the fetus, though some studies have shown few or no long-term effects from their use.

Today, only a fraction of family members of substance users receive education in SUD science and effective ways to support recovery.  And many people view the substance user as the enemy – who “asked for it” when addicted – because they do not understand, and cannot comprehend, the unbelievable power of the drug.

How do we reach the ideal world? Look at one aspect of the problem.

Mandated reporters rightly make reports when infants are exposed to harmful drugs, and our overburdened, underfunded child welfare system becomes involved.  According to the 2016 Annual Child protective Services Report, (PA Department of Human Services) the large majority of calls to General Protective Services (GPS, reports that don’t rise to the level of child abuse but services to prevent harm to children are needed) involve parental substance abuse, with mothers being the person most reported. As the opioid epidemic grows, the Commonwealth has not responded to the critical needs of children of substance users to the extent that is needed. The numbers of effected children are not declining; what are we waiting for?

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While services vary from county to county, some counties have no alternatives to removing children from the home. If it is safe – by providing ongoing treatment, support and education to mothers – to keep babies with their mothers, that should be the first goal of our child welfare and SUD treatment systems.

“These mothers will stay clean if we show them that they can bond with the baby, that they are successful,” says Kimberly Spence, a Missouri neonatologist recently quoted in the Post articlenoting that taking the baby away can exacerbate the mother’s drug problem. “They no longer have a reason to stay clean.” She typically puts newborns with NAS on a tapering dose of morphine to reduce withdrawal symptoms. At the same time, mothers are offered recovery drugs to help them maintain their recovery as they commit to quit using drugs and become nurturing parents.

One way that PA Family Support Alliance is a part of the solution is our Recovering Families program, a parenting curriculum specific to parents as they recover from SUD. For people engaged in 12-step programs, the slogans and steps are discussed in the context of parenting.  It covers topics like how to talk to children about SUD and recovery, the importance of balancing parenting responsibilities with the needs of recovery, and the impact of substance use on child development. We provide materials and training to organizations who work with parents in recovery; these local providers now offer Recovering Families across Pennsylvania and several other states.

As we each have a role to play in preventing child abuse, we each have a role to play in helping children – and parents – effected by drug use. September is National Recovery Month, a great time to become part of the movement toward an ideal world.

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