Drug use during pregnancy: Mothers (should) know best

If you have not already done so, it’s a good idea to read the introduction to this discussion first.

Happy pregnant womanI started this conversation on May 7, 2008 11:49 PM:

This week’s question is a particularly challenging one. At first, it would seem fairly straight-forward (though obviously politically and ethically charged): Of course a woman should avoid drug use during pregnancy! Mothers are expected take care of their children to the best of their ability, born or unborn. It’s part of the nurturing aspect of motherhood.

A problem arises when the pregnancy is unexpected and unplanned. Often the first sign of an unexpected pregnancy is a missed period. Depending on when in her cycle the woman becomes pregnant, it can be almost two months before she realizes she is pregnant. If she has preexisting health conditions that cause frequent missed periods, it could be even longer before she discovers she is pregnant. During that time, it is unlikely that she will change her normal social habits (i.e., stop drinking alcohol and double lattes; cease using recreational drugs if she is into that). As a result, during some of the fetus’ most important developing months, the mother could, without knowing, endanger the outcome of the pregnancy.

The “obvious” solution, as alluded to in our textbook, is for “women of childbearing years” who may become pregnant to avoid actions that could harm a fetus. That is sound advice for planned pregnancies, but it is still a challenge. There are many substances that act as drugs and can affect a developing fetus including alcohol, caffeine, over the counter and prescription medications, tobacco smoke and second-hand smoke, and auto exhaust just to name a few.

Looking beyond planned pregnancies to the unplanned ones, it means that practically every woman who could potentially become pregnant should refrain from living in our modern world, especially from all the social activities common to “women of childbearing years.”

While well intentioned, creating new laws that punish women who endanger their developing fetuses with drugs only makes things worse. There are already many laws that deal with illicit drug use, and any mother using drugs is already breaking those laws. That should be adequate. Otherwise, any new laws would need to have a safe harbor clause, something that limits a mother’s culpability to decisions made after a medical professional has confirmed her pregnancy.

Otherwise, from menarche to menopause a woman would have to abstain from all situations and use of substances that could potentially cause birth defects or other problems. On the off chance it might cause harm to a fetus, few women would want to risk punishment for enjoying life a bit. Imagine what such a law would do to nightclubs, Starbucks, and roller coasters!

That is a bit facetious, but I do not believe that punishment is a solution. It is a nasty can of worms that creates problems and solves none. Any mother who cares about her child-to-be will act responsibly, and any harm brought about by her inappropriate actions will be punishment enough. Any mother who does not care about a fetus probably will not make a very good mother, and the increased chance for miscarriage may be a natural way to weed bad mothers from the gene pool.

There is also the question that plagues any discussion concerning pregnancies: “When does a developing fetus ‘become’ a child?” It is the question of when a combination of sperm and egg becomes a unique living creature and not just a symbiont within its mother. If a fetus is “born” at the moment of conception, then anything that harms the developing fetus would be harm done to another person. If a fetus remains a part of the mother until it is “born” through the childbirth process, then any harm done to the fetus is harm done to an extension of the mother, not a separate person.

My personal opinions fall somewhere in between the two extremes. As a result, I feel that in the early stages of development, many of the decisions relating to the pregnancy are the mother’s alone to make. At some point, though, the unborn baby becomes a separate life form. This probably happens around the fifth month of pregnancy during the quickening (Kolander, 220). Certainly by the time the child can be safely removed from the womb as an extremely premature baby, it can be considered its own being. From this point on, both the needs of the mother and the unborn baby should be considered. I still do not believe the mother should be punished if her actions harm the baby, because either her remorse will be punishment enough. If the baby dies and the mother feels no remorse, it was probably better off without the woman as its mother. That may sound a bit harsh, but it is the way of things in nature.

In summary, I believe that a good mother does have a responsibility, once pregnancy is discovered, to take reasonable care of herself and avoid harmful situations and substances that could adversely affect the developing fetus. A woman who ignores the fetus’ safety has an increased risk of miscarriage, and that is probably for the best. Punishment is not warranted when a mother endangers her child whether by using recreational drugs, over-the-counter medicines, alcohol, caffeine, second-hand smoke, or otherwise; the mother’s own remorse should be punishment enough. A mother’s rights trump those of an unborn fetus, but once the fetus develops into a separate living entity, its own future should be considered along with the mother’s. Ultimately, decisions affecting a mother and the baby should be left to the mother, with the consultation of qualified medical professionals, and the law should not make matters any more difficult for the mothers than they already are.

—Will

References:

  • Kolander, Cheryl A., Danny Ramsey Ballard, and Cynthia K. Chandler. Contemporary Women’s Health. Third edition. 2008.

Justine replied to me on May 8, 2008 7:02 AM (CC-BY-SA-3.0-US Licensed; read more info):

Wow, this is obviously the topic that hits buttons for us all. I like that you addressed pregnancy when it came sometimes be an accident. It’s important for us to emphasize contraceptives for those who are sexually active but not planning for pregnancy. I know the government offers things like Planned Parenthood, but maybe it should be better advertised to show women that they can be given contraceptives, pregnancy tests, and so on and places like this. In sex education they make abstinence THE choice and say that if you’re going to be sexually active then they give your contraceptive options. Maybe in sex education they should make abstinence the option and tell them the types of contraceptives as what the should do. I’m not sure if this would make a difference but I know when I took sex education in junior high school, we went over the types of contraceptives so quickly that I barely recall going over them.

I definitely think some sort of punishment should be made to a mother that harms her child with drugs. It’s hard to make something like that because there are so many young mothers in today’s society that don’t know they are pregnant until very far into their pregnancy. I wish a punishment could be agreed upon but I think it’s unlikely an agreement will ever be made about that.

I replied to Justine on May 8, 2008 8:51 PM:

Thank you for your comments, Justine. It’s obvious that we don’t see eye to eye on every aspect of this issue, but I think we both have our hearts in the right place. We just want to see mothers having the option and ability to do what’s right and then actually do it.You remember sex ed? And they actually taught you something useful?

The paltry bit of sex ed (“maturation”) I remember occurred when I was in 6th grade. The girls in the class were sent to one room; the boys went to another. We were all seated in a double row. The nurse had some flip charts. All of the boys, including me, sat awkwardly casting odd glances at each other and occasionally letting out little snickers. Our male teacher tried to play it cool. The nurse gave a very boring presentation that basically didn’t say much except that as men grow up they get bigger, hairier, and can make a baby with a girl if they have sex. If there was more to it than that, I really don’t remember it. I certainly don’t remember hearing about any contraceptives, other than a condom, being discussed. It was a “shock and awe” type of presentation done to meet some State requirement, and there was maybe only a glimmer of interest or expectation that we would actually learn anything… at least anything beyond what we had already learned in second grade from the more knowledgeable third graders. I’m being 100% serious here. That was it for elementary school.

When we moved on to 7th grade (Jr. High School, not “middle school” back then), “maturation” was incorporated into our science class. First we discussed how the flowers do it. Then we discussed out the lower life forms do it. Then we moved on to mammals and finally humans. This at least got into some interesting stuff, like spermatozoa, ovum, chromosomes, and recessive traits. I think we also watched a movie about sex, but the movie was from 30 years earlier or so, and it was really dated.

Jump ahead to Biology in high school, and we learned a lot more about the biology of reproduction, but nothing about childbirth, contraception, abortion, or anything even resembling something controversial like that. I think the only thing halfway controversial was the students who refused to dissect frogs (and oh how I wished I could have been one of them!).

Now you see why I am amazed that your school actually taught you anything useful about sex. I don’t think the boys in my 6th grade class were quite ready for an intellectual discussion on the topic, and the nurse sure wasn’t going to go out of the way to instill anything other than the State required curriculum into our sheepish brains.

Now to dispel a few misconceptions:

The primary focus of sexuality education in our schools has been focused exclusively, or almost exclusively, on abstinence. This is because federal entitlement programs tie funds paid to the school to the requirement that schools promote abstinence-only-until-marriage programs. In 2007, $204 million was proposed for payments to schools for such education. (Kolander, 25)

Is it any wonder that if kids (gasp!) actually have sex, they don’t know much of anything about effective ways of avoiding pregnancy? Sure abstinence is a great policy, and I highly recommend it. I also highly recommend not falling into the middle of a swimming pool if you don’t know how to swim. But in both cases, if you somehow end up in those situations, isn’t it better to know how to safely get out of the deep water and avoid serious problems?

Planned Parenthood Federation of America (PPFA) is not run by, endorsed by, or funded by our government. After all, PPFA actually mentions that abortion is an option. Certainly such an outrageous organization could not receive funding from our conservative federal government no matter how many women and children it might help. 😉

I will discuss the “punishment” issue in my next post.

—Will

Gayle Newton replied to me on May 8, 2008 2:57 PM (CC-BY-SA-3.0-US Licensed; read more info):

You are right there are many women who have irregular cycles. But 98% who take birth control pills can stay regular. So an unexpected pregnancy is usually the fault of a women not taking her pill everyday. In that case, like you said she would not even know she was pregnant until she skipped her period. And if she was or is a partier then she has already done harm to the fetus. But once is knows she is pregnant she has the moral responsibility to her unborn child and give it every chance at a healthy growth for the next 7 months. You mentioned all the free radicals with live with on a daily basis that cannot be avoided. But I think the main point here is the intentional drugs women put into their body. Many women in their childbearing years can enjoy all social activities, but just refrain from ingesting anything harmful. I will have to agree that in most social situations second hand smoke is the hardest to avoid. You made many good points. I won’t get into the punishment aspect of this. Anyone who read my initial post knows where I stand on this issue.

I replied to Gayle on May 8, 2008 9:56 PM:

Tell me about it! I grew up with pretty severe allergies and also asthma. Until California passed its various no-smoking in public places laws, it was miserable trying to eat at a restaurant, see a show, or attend meetings. Somebody, somewhere, would light up a cigarette and the smoke would waft over to me. I feel sorry for smokers who have to go outside to smoke in the cold, the rain, or even the Sacramento summertime triple-digit heat—not because they having to go outside to smoke, but because they are so addicted to a (legal) deadly drug that they put up with all sorts of miserable conditions just to get another nicotine fix. If that doesn’t show how addictive drugs are and how difficult it is for people to quit drugs, I don’t know what does.

My next post delves into nicotine and other addictions much more in depth. Thanks for another good response, Gayle!

—Will

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