Should Pregnant Women Who Use Drugs Be Punished?

Senga Carroll is the training director at UNC Horizons, a program that provides counseling, case management and medical care to pregnant women with substance use dependency in Chapel Hill, North Carolina. She sees the practical consequences of the condemnation of pregnant women who use drugs.

“Pregnant women with substance use disorders face shaming by health care practitioners and society when they seek medical treatment,” says Carroll. “Hospital staff often condemn the women by saying, ‘The baby is having a hard time because you are a bad person.’ When women feel judged they may lie to health care providers, and [the] lack of information makes is harder to provide the best treatment for the mother and baby.”

Currently, protocols for how to respond to a pregnant woman who may be using opioids, or a baby born with evidence of dependency, vary widely from hospital-to-hospital. Some staff members may even call Child Protective Services to separate the baby from its mother, even when the mother is on medication-assisted treatment such as methadone. Fear of judgment and condemnation drives pregnant women who use drugs underground, away from drug treatment or prenatal care. Some women try to detox off drugs on their own, though the abrupt cessation of opioids can lead to pregnancy complications. Other women opt for home births to avoid hospitals altogether. Home births are risky for babies born with exposure to opiates, as specialized medical care may be necessary to relieve their symptoms.

The recommended treatment for pregnant women who use opiates is medication-assisted treatment (MAT), such as methadone or buprenorphine, in the context of broader services such as screening, assessment, a treatment plan and evaluation. But MAT can be controversial. Opponents of MAT often call it a substitution of one drug for another. They point out that half of babies born to mothers who used methadone or buprenorphine treatment while pregnant still exhibit withdrawal symptoms.

For Carroll, such criticism ignores five decades of research that clearly point to MAT as the better alternative to abrupt detox while pregnant.

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