March 15, 2012

Helping Substance-Using Pregnant and Postpartum Women

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Katherine J. Davis, BS, and Kimberly A. Yonkers, MD

Yale University School of Medicine, New Haven, Connecticut


In situations involving substance use by expectant women and postpartum mothers, there is often a sense that the interests of the mother are not aligned with the interests of the child. As a result, unfortunately, clinicians sometimes focus solely on the child and neglect the importance of the mother’s health and the maternal-child relationship. In our recent case report about the effective use of external pressure with pregnant and parenting substance-using women, we tried to demonstrate the need to attend to both maternal and child health, to the benefit of both.

In fact, a child often has a positive impact on a new mother’s recovery from substance abuse, and the child benefits from a strong and healthy maternal-child bond. Our interactions with substance-using mothers reflect this reality. Mothers often relay to us their desire to get well for their child, and they look to the pregnancy and the postpartum period as a chance to recover and start anew. This is why the manner in which health care providers handle the immediate postpartum period is critical.

Our report was driven by our response to an event at a local institution, wherein a new mother (Ms A) was forcibly removed from the hospital prior to her baby’s discharge. She was sent away in a taxi, despite her insistence that she had nowhere to go except a house where drug use was prominent. That day, Ms A relapsed, after the weeks of abstinence she had achieved. In this case, intervention by family services could have been handled in a more sensitive and less confrontational fashion.

An alternative scenario would be for clinicians to work with the mother during pregnancy and the immediate postpartum period and encourage her to enter or continue in treatment. Treatment success has been linked to patients’ perceptions that counselors are respectful, sincere, and nonjudgmental. The eventual goal of fostering this collaborative relationship between clinicians and mothers and achieving the mother’s abstinence from substance use is mother-child reunification. Working with the mother during pregnancy and in the postpartum period builds upon the implicit pressure many mothers already feel to stop using substances and be available for their child. Appropriate support for both the mother and child, in terms of health care, parenting services, and many of the concrete needs that disenfranchised mothers experience, promotes mother and child well-being.

Financial disclosure:Ms Davis had no relevant personal financial relationships to report. Dr Yonkers has received study medication from Pfizer for an NIMH trial and has received royalties from UpToDate. ​

Category: Substance Use Disorder
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