1. Susan Boyd, PhD
Samantha Hardeman, RN BScN
Brittney Willetts, BA, BSW, RSW
May 22, 2013 AHRC Confrence
2. Inner city drug using population often experience
high rates of stigma and discrimination
Add in pregnancy and things become exponentially
more complex
People’s focus tends to stray towards the fetus and
on what the “horrible” woman is “doing to it”
People forget that addictions and
mental health don’t just go away
when a woman becomes pregnant
May 22, 2013 AHRC Confrence
3. Pregnancy will make it even harder to discuss
substance use
Study cigarettes vs. Illicit drug use
Pregnant women will need a lot more sensitivity
from workers because they will assume the
worker will judge them and very often feel guilt
within themselves
This will prevent pregnant
substance using women from
accessing services
Supports need to be intensified
instead of being taken away
May 22, 2013 AHRC Confrence
6. Opiates = no negative developmental
effects on fetus
Used in early labor as pain control
method
When a pregnant woman is physically
dependant, withdrawl effects on mom
can have a negative impact on the fetus
Increased BP= less blood flow to baby,
stress response, hormonal fluctuations,
etc.
Less withdrawing is safer for baby
May 22, 2013 AHRC Confrence
7. Minimizes withdrawls by
maintaining steady dose
of opiates
Once an adequate dose is
established... DON’T decrease dosage.
The drug dependant baby (NOT addicted)
will still withdraw when born. This is
manageable (non-medically and
medically) and does NOT lead to long
term complications
May 22, 2013 AHRC Confrence
8. Positive step
Some workers do not fully understand the
benefits of maintenance programs
Some believe still active in her addiction
and labelled as unable to care for baby
The mom may want to wheen off to “look
better”
May 22, 2013 AHRC Confrence
9. No one knows how much alcohol and when in
the pregnancy it will cause developmental
issues
Frequently new “reports” with conflicting
research frequently
Might be more socially acceptable to have a
drink than a point or a hoot
Mom with FASD: Doesn’t mean she can’t
parent, just means she will need more
structure and supports. Need special
attention and supports given to them
specifically.
May 22, 2013 AHRC Confrence
11. Neonatal Abstinence Syndrome (NAS)
Policy: Baby separated from mom and sent to NICU or
nursery for monitoring
Best practice is to have baby room in with mom,
kangaroo care, breastfeeding
Fir Square
Baby drug testing
Very subjective on who to screen
In our experience and in the literature non-Caucasian
women are more likely to be screened
Calling the social worker
Health care workers tend to focus on the physical and
negate the social determinants of health
Not enough time, not enough staff
May 22, 2013 AHRC Confrence
12. If a pregnant woman has other kids in care, she may
have difficulties accessing neonatal funds she is
entitled to with current pregnancy
Not eligible until third trimester for income supports
Need a letter from doctor with due date to prove
gestation. In order to get it you need regular prenatal
care (ultrasound and Dr visit)
Individuals are often turned away from Income
Supports and confused as to why. Usually a smoother
process when staff are present
Individuals may not know policies resulting in a lesser
ability to advocate for themselves
If an individual is turned away once, they are
typically reluctant to go back
May 22, 2013 AHRC Confrence
13. Legislation states that a baby is not considered to be a life until it is born
Pros
Women are not being sent
to jail for child abuse
Women can go on
Methadone or Bup without
having the law involved
Can disclose drug use to
Doctor without having the
law involved
CS cannot become
involved until baby is born
– gives her the time to set
things up, detox, etc.
Cons:
No supports offered before baby
is born
People avoid going to children’s
services when its a minor
concern. Takes a lot of
advocating, and children’s
services being receptive to the
idea of change.
Less opportunity to build a
positive relationship with CS
Most CS offices are more prone
to apprehending before assisting
to put supports in place
May 22, 2013 AHRC Confrence
14. “Increasing the number of pregnant women
who use drugs who receive prenatal care
requires systems-level rather than only
individual-level changes. These changes
require a paradigm shift to viewing drug use
in context of the person and society and
acceptance of responsibility for unintended
consequences of public health bureaucratic
procedures and messages about effects of
drug use during pregnancy.”
Roberts, S. C. M., & Pies, C. (March 2010). Complex
Calculations: How drug use during pregnancy becomes a
barrier to prenatal care. Maternal Child Health Journal, 15,
333-341.
May 22, 2013 AHRC Confrence