Brandi Williams was up smoking crack cocaine for two days straight when she realized that she was about to go into labour.
Williams was forced to drag herself to the hospital on a cold morning in Tennessee, December 2014. She borrowed a vehicle from a friend who was so intoxicated that he had to attach a breathalyzer to the starter of his car.
Williams recalled, “Here I was in full-blown labour, driving myself, and I could feel the baby’s face, like, right here.” “And I have to blow into this machine, or else the car will shut down.”
She arrived at the hospital on time. Williams, as she entered the hospital to deliver her daughter made one final preparation.
She threw her crack pipe in a garbage can.
Williams’ honesty is veiled in a sad humility. “I was ashamed I continued to get high while pregnant. “I was ashamed that I couldn’t stop.”
Doctors say that drug addiction treatment during pregnancy is safe for the mother as well as the child. Methadone, buprenorphine and other drugs can help reduce cravings, and even help pregnant women carry their pregnancy to term without any long-term effects for the baby.
Many pregnant women are discouraged by shame and stigma like Brandi Williams.
The fear of state welfare authorities taking their babies away is a bigger deterrent. Based on their interpretations of federal laws, some states view substance abuse during pregnancy as such a heinous crime that it warrants criminal prosecution.
It’s for this reason that a growing number experts, including those who treat addiction and federal health officials, are calling on the law to be changed.
Nora Volkow (Director of the National Institute on Drug Abuse, NIDA) said in an article that we should no longer criminalize women who are pregnant while taking drugs. “That has to stop.”
Substance abuse disorder does not indicate a person’s parenting ability, according to Dr. Hendree J. Jones, executive director of University of North Carolina Horizons Program. Horizons is a drug treatment program that offers comprehensive care to anyone who has the capacity to give birth to a child.
Jones: “I’m working with a woman who is about to give birth and is afraid that they will find drugs in her body and Child Protective Services will be called, and her baby is going to disappear.”
The study, published in the Maternal and Child Health Journal on Wednesday and involving 26 pregnant women from Massachusetts, found that the decision to take antiaddiction medications “was completely wrapped up” in the mandatory reporting to Child Protective Services during delivery. Dr. Davida Schiff is the author of the study and an addiction medicine expert at Massachusetts General Hospital.
The study found that women in the study experienced “intense stress and anxiety” when they were threatened with being reported to CPS.
Schiff explained that “this has led many women to either decide not to start life-saving medications during pregnancy, or to wean themselves off those life-saving medications during pregnancy, and risk really poor outcomes for them and their babies.”
Massachusetts is not the only state affected.
Laura Faherty is a policy researcher with the RAND Corporation. She said, “Across the country, we are seeing a trend towards more punitive polices, which consider substance abuse during pregnancy as child neglect or abuse.”
Change is urgently needed.
According to a study, the rate of women diagnosed with opioids during pregnancy increased by 131% between 2010 and 2017. The research is still ongoing, but addiction experts predict another significant increase in rates after 2017.
The No. The No. 1 cause of avoidable deaths among pregnant women and postpartum woman is not pregnancy related at all. NIDA’s Volkow says it’s drug overdose.
Volkow stated that “we know that the mortality rate from overdoses in pregnant women is higher than that of their counterparts who are not pregnant.” This is important, because it tells us that pregnant women are more vulnerable.
According to a report that was published last year the number of pregnant and new mothers who died of drug overdoses has reached a record in 2020. It is now 11.85 per 100 000, compared with 6.56 per 100 000 in 2017.
“Fetal Personhood” and Substance Use
Congress passed the Child Abuse Prevention and Treatment Act (CAPTA) in 1974. The act requires that all states have a plan to deal with and respond to cases of child abuse and negligence.
Over time, the law has evolved and includes a provision that says child abuse may include babies affected by drug withdrawal.
Each state is responsible for interpreting CAPTA.
According to the Guttmacher Institute, an organization that conducts reproductive health and policy studies, 25 states, including Washington, D.C., consider substance abuse in pregnancy as child abuse. These states require that health care providers report to authorities any suspected prenatal drug abuse.
Doctors say that the effects of methadone and suboxone prescribed by doctors to pregnant women who are addicted can be seen in their newborns, but they will not last long.
We know that drugs for opioid addiction disorder reduce the risk of fatal overdoses. Also, they improve pregnancy outcomes. This increases the likelihood that babies will be born at full term. Dr. Stephen Patrick is a Nashville neonatologist, and director of Vanderbilt Center for Child Health Policy.
Many local communities, and even hospitals, may interpret the law in a different way, leaving expectant mothers, and their doctors, confused about whether or not to comply.
In fact, a growing group of experts are concerned that CAPTA’s interpretation and the state’s interpretation of its definition of “abuse in utero” have gone too far.
The law’s intent may not have been punitive but how it is implemented in a particular community or child welfare office, can feel like a punishment, said Dr. Marian Jarlenski. She is the associate director of Center for Innovative Research on Gender Health Equity, University of Pittsburgh Medical Center.
This is going to get much more complex as states ban or criminalize abortion care. Jarlenski stated that we are moving towards a situation of ‘fetal persons’.
Some people say that the criminalization of substance abuse during pregnancy is misguided.
What is the problem that we are trying to solve? Patrick said. “I treat more complications in NICUs from untreated diabetics than from opioid addiction disorder.”
Patrick said: “Imagine we told someone who has uncontrolled diabetes that if their baby is born weighing 12 lbs because they have uncontrolled diabetic, there may be child welfare involvement.” “That sounds insane.”
Women left pregnant without assistance
It is no surprise that women who are pregnant already consume alcohol or drugs like opioids.
It can be difficult to find resources that will help women who are pregnant.
“Addiction specialist can be hesitant or reluctant to treat pregnant women,” Dr. Jeannie Kelley, medical director of the maternal-fetal transportation at Washington University School of Medicine St. Louis. It can be difficult to treat pregnant patients because of the uncertainty about what treatments are safe.
Kelly stated that “on the other side, obstetricians are not traditionally very well-trained in addiction care.”
She said that we’re now left with “a perfect storm” where patients are without anyone to take care of them.
The road to sobriety
Brandi Williams was aware that she could not bring her daughter to live in a dangerous place, where she said she could not even care for herself. She gave her baby up for adoption but stays in touch with the parents who raised her.
The health of the little girl was not affected in any way. Williams proudly declared, “She’s so freaking intelligent.”
Williams, who is now 40 years old, became sober with suboxone in 2021. She continues to take the drug “because it beats me sticking a narcotic in my arm.”
Williams is employed and pursuing a psychology degree so that she can provide counseling for substance abuse to those in need.
Williams said, “If I’m able to come out of this, everyone can.” “You’ve got to want it badly enough.”
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