Punishing the Mother Is Not Best for the Baby

Since 2000, nurses and other healthcare providers have witnessed a five-fold increase in the number of newborns experiencing withdrawal symptoms due to in utero exposure to harmful substances, most often opioids. Symptoms range from blotchy skin and sneezing, to respiratory complications, low birth weight, prematurity, feeding difficulties, extreme irritability and seizures.

While prescription opioids are among the most effective medications for the treatment of pain, regular or long term use can lead to physical dependence and, in some cases, addiction. A growing number of women are taking prescription opioid pain relievers when they find out they are pregnant. Other women may be prescribed these medications during pregnancy for managing pain. While medication use is not uncommon, safety information in the pregnant population is lacking.

Caring for infants exposed to opioids in utero can be challenging and expensive. Watching a delicate newborn experience discomfort and pain and having to be separated from family because of an extended hospital stay is emotionally stressful to parents, and may interfere with breastfeeding and family bonding.

Nurses have identified some important ways to help alleviate discomfort for these infants by providing quiet environments with low lighting, using soft voices and pacifiers, feeding frequently in smaller amounts and vertical rocking. Protocols vary widely from hospital to hospital and there is still much to learn about how best to identify and care for these babies.

Unfortunately, a number of states have passed laws or applied existing laws that aim to reverse the trends in newborn opioid exposure by criminalizing women who use these substances during pregnancy. Proponents argue that the threat of arrest and incarceration will deter women from using substances. Last year, Tennessee passed such a law.

Mothers may refrain from seeking care if they feel they would be putting themselves at risk of incarceration. Yet regular prenatal care improves pregnancy outcomes for women and infants, especially those with substance abuse disorders. Anecdotal reports from Tennessee confirm that women are avoiding prenatal appointments. Additionally, they are having unplanned home births or crossing state lines so they do not have to birth their babies in Tennessee. This year, my home state of North Carolina has introduced similar legislation that would jail pregnant women who use drugs.

Screening for drug use and offering treatment to the pregnant woman is much more effective in preventing symptoms associated with infant withdrawal than jailing women. Research indicates treatment for substance abuse disorders for pregnant women can be cost effective or even cost-saving in combination with individual or group counseling, medical care, and social services.

Incarceration is not the answer. Pregnant women with substance use disorders need to be identified early in their pregnancies and offered treatment. Medication and behavioral therapies serve as important elements in recovery. Incarceration, on the other hand, is shown to be ineffective at reducing the incidence of substance abuse.

The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) calls on policymakers to oppose laws that criminalize women because of a substance use disorder during pregnancy. The criminal justice system is not the right environment for a woman to receive treatment for a medical condition; the healthcare system is where she belongs.

AWHONN supports a coordinated, federal response to the issue of opioid addiction during pregnancy and treatment for newborns exposed to opioids in utero. While different hospitals are caring for these infants using a variety of methods, a standardized, evidenced-based approach will give nurses better tools for evaluating, diagnosing, and treating these women and infants.