Drug And Alcohol Rehab Centers For Pregnant Women

Medically reviewed by

Debra Wallace, MA.Ed, LPCC-S, LICDC-CS

February 5, 2019

Treatment for Pregnant Women Affected By Substance Abuse: What You Need To Know

One of the biggest substance abuse problems among pregnant women is opioid abuse—opioids include illicit narcotics, such as heroin, and prescription medications, such as painkillers. Some of these prescription opioids are:

• Buprenorphine
• Codeine
• Fentanyl
• Hydrocodone
• Hydromorphone
• Meperidine
• Methadone
• Morphine
• Opium
• Oxycodone
• Propoxyphene

As cited by the American Congress of Obstetricians and Gynecologists (ACOG), the 2010 National Survey on Drug Use and Health found that approximately 4.4% of pregnant women admitted to use of illicit drugs in the last 30 days. Because of this staggering percentage, it’s imperative that doctors and pregnant women alike be aware of the effects of substance abuse on pregnancy, and how to treat and manage it.

Substance abuse treatment may include a detoxification process, or a time period in which the body rids itself of the negative chemicals acquired through prolonged use of drugs or alcohol. Detox time depends on the woman, the substance, and how long she has abused it, but can range anywhere from six hours after the last usage to 10 days, according to the New York State Office of Alcoholism and Substance Abuse Services.

The detox process can be incredibly dangerous, and proper care must be sought in order to ensure the health of the woman and her child. Unfortunately, babies born to mothers who have struggled with substance abuse prior to birth may experience withdrawal symptoms as well. Symptoms can occur anywhere from three hours to 12 days after birth, but only those affected by opioid withdrawal should need treatment.

How To Know If A Pregnant Woman Is Struggling With Substance Abuse

Because substance abuse creates a risk-laden environment for pregnant women and their unborn babies, it is important to understand the signs of substance abuse, and to be able to identify them when necessary. The ACOG cites the following signs of substance abuse:

• Waiting to get prenatal care until late in the pregnancy
• Regularly missing appointments
• Failing to gain proper weight
• Appearing sedated
• Signs of intoxication
• Withdrawal symptoms
• Reckless behavior

There are also certain physical cues, such as:

• “Track marks” from use of intravenous substances
• Skin lesions from injections, also called “skin popping”
• Abscesses
• Cellulitis

What Are The Risks For Babies Affected By Substance Abuse?

Even if a mother is treated for substance abuse during pregnancy, the newborn baby may still experience withdrawal symptoms. It is important to know the signs and possible effects before undergoing treatment. Babies who are experiencing neonatal abstinence syndrome (NAS) due to a mother’s opioid abuse, may be at risk for feeding troubles, respiratory issues, seizures, and in worst cases, death. It is important to note that in cases when neonatal abstinence syndrome is expected in babies, it is treatable, especially if women who are pregnant receive proper prenatal care and work closely with a pediatric team.

Substance abuse, especially opioid abuse, can also pose increased risks to the unborn child during pregnancy, such as restriction of growth, placental abruption, preterm labor, passing of meconium in the uterus (which causes an infection), and fetal death.

Using Medications Within Treatment

Consideration of medications used during treatment should carefully assess the risks associated with each medication. Pregnant women’s bodies change throughout the entire pregnancy, and this affects how medications are metabolized. In other words, the body metabolizes medications and substances differently from the first trimester to the third trimester, as well as after pregnancy.

Both pregnant women seeking treatment for substance abuse and their physicians have to consider the risks versus the benefits. One thing is certain: ridding the body of toxins acquired through substance abuse and stopping future use, helps to diminish further risks or complications. In any case, careful consideration of treatment methods is key. As the National Institute on Drug Abuse (NIDA) explains, “research has established the value of evidence-based treatments for pregnant women (and their babies), including medications.”

One medication used in treatment, methadone, is not approved by the FDA to treat pregnant women struggling with substance abuse, but has been proven to be effective in treating pregnant women who have been victims of heroin abuse. When treating with a medication, such as methadone, close monitoring of dosage is key to avoiding withdrawal. Some signs of withdrawal include anxiety, difficulty sleeping, irritability, nausea, and stomach cramps.

Recent studies have also shown buprenorphine to be effective in treating pregnant women for opioid abuse, and has produced lower withdrawal symptoms for babies which leads to a shorter stay in the hospital. It is being used more and more frequently as it presents less risks to the unborn child, less risk of overdose for the mother, and is administered in fewer dosages (and thus less interactions with drugs). With the reduced risks, pregnant women being treated with buprenorphine may be able to seek outpatient care versus inpatient care (hospitalization or residential care). However, the ACOG warns that “patients considered for using buprenorphine need to be able to self-administer the drug safely and maintain adherence with their treatment regimen.”

Some publications urge that pregnant women should not be given naloxone or other antagonist medications except during emergency situations to save their lives. Use of overdose reversal drugs can cause preterm labor, and enhance risks to the unborn child. However, the Substance Abuse and Mental Health Services Administration (SAMHSA) asserts that “Pregnant women can be safely given naloxone in limited doses under the supervision of a doctor.”

For pregnant women struggling with addiction, a comprehensive treatment plan should go beyond medications. According to ACOG, the treatment plan should work to prevent complications of further substance abuse and withdrawal by encouraging prenatal care and continued treatment, which then prevents further risks to the pregnant woman resulting from an association with drug culture. These actions are also aimed at reducing or stopping illegal activity.

The Necessity Of A Good Program

Just as treating a dual diagnosis, treating a pregnant woman for substance abuse must address both care for the mother and care for the unborn baby—both have special needs, some of which overlap. Women have specialized needs for substance abuse treatment, such as emotional concerns which may make treatment difficult. Therefore, treatment methods for pregnant women should utilize a woman-centric model that caters to the unique needs of women. Treatment may include behavioral therapy, medication, and strong support from medical staff and/or family and friends.

An addiction or substance abuse isn’t something anyone should deal with on their own, especially someone such as a pregnant woman with these unique and pressing concerns. A good program will address the specific health and medication needs as we’ve noted above. It should also strive to address the underlying issues that may have pushed a woman towards substance abuse in the first place.

Behavioral therapies can be crucial within this situation, allowing both the individual and therapist a venue by which to ascertain this, in a capacity that helps them to incite change and develop critical coping skills that may aid the woman in dealing with these situations in the future.

In addition, these therapies should address and seek to treat any co-occurring conditions, such as depression, anxiety, bipolar disorder, or borderline personality disorder, that may be fueling or exacerbating the substance abuse and addiction, in order to give the woman the greatest chance at success.

Finally, treatment programs for pregnant women should take into account any needs they may have, to help aid in treatment. For example, addicted individuals may face daily hardships related to housing situations, transportation, getting proper nutrition, finding access to necessary medications, fear of seeking treatment due to risk of repercussions, keeping away from substances during and after treatment, and more. A great treatment plan should help address these issues, and offer or provide resources to help solve them.

Substance Abuse Treatment For Pregnant Women—How To Find Help

Treating people who are victims of substance abuse can be a delicate process; treating pregnant women who are victims of substance abuse can be twice as delicate. Inpatient rehab centers must address all potential threats to the woman’s health, and the health of the child, while carefully weighing the available treatment methods to ensure that all needs are met.

If you are pregnant and abusing or addicted to drugs or alcohol, you are not the only one. Contact us today at Rehabcenter.net to speak to someone who will listen to your concerns, point you down the path to recovery, and help develop a treatment plan that is right for you.

For more information, check out our guide on addition and pregnancy here.