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

4. “Addict”
“Addicted babies”
“Prostitute”
Substance “use” vs. “abuse”
“Prostitute”
“Crack Babies”
“Hookers”
“Heads”
“Bum”
May 22, 2013 AHRC Confrence

5. 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

10. 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