Drug use during pregnancy: Why punishing mothers who use drugs does not work

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

A close of of tiny baby feet with a teddy bear in the backgroundA student who wishes to remain anonymous and did not give her permission to publish her comments replied to me.

She congratulated me on a well executed and thoughtful post. She appreciated that I mentioned that many pregnant women are unaware of their pregnancy for a while, because it does not seem fair to her that a mother should be punished for endangering a baby she doesn’t even know she has. She agreed that guilt for any harm caused to the baby would cover the punishment in the end. She then asked me a few specific questions, which I addressed in my response.

I replied on May 8, 2008 10:10 PM:

Hi. Thank you for your response and the complement. I certainly hope that maintaining a normal lifestyle until a pregnancy is discovered never becomes a crime. The following response is not directed at [the anonymous student] specifically.

The post contains some of my thoughts directed to anyone who feels that legal punishment toward a drug-using mother is the right thing to do.

I think that many people in the class imagine that drug abuse is a bit like a faucet. While stopping cold turkey is hard, you can just dial back the amount you use over a few days or maybe a week or two, and you’re cured of the addiction. If only that were true!

I’m not saying it’s impossible for women, upon discovering they are pregnant, to decide to quit using drugs and stick with it through the pregnancy (and hopefully beyond). It’s just that the odds usually are not in her favor. First, there is the highly addictive drug itself. They create physical, mental, and emotional hooks into the person. Get one or even two under control (thinking about the baby coming and then flushing the drugs down the drain), and another of the hooks reels the addict back in (a stressful day at work could be unbearable without a fix, and before she knows it, she’s using the drug again).

There is also usually an environmental issue that led the woman into the pattern. Perhaps her boyfriend or husband is a user, too. He tells her she needs to quit, but he continues to use the drug in front of her. Aside from the obvious double-standard, seeing the drug use is like holding a flame in front of a moth. Eventually, she will get burned. If not a significant other, it might be friends that she is around. Perhaps (and this often is an unfair and false stereotype) she comes from a poor urban neighborhood where drug use is rampant. Peer pressure doesn’t suddenly disappear just because you are pregnant. Many pregnant women who used drugs during their pregnancy have babies that appear to be fine. Maybe the odds will favor her, too, just like her friends and neighbors. “This is reality after all, not some scary TV documentary or drama. They make that stuff up just to scare us.” And her friends tell her how right she is. Who is she going to believe? Her peers or some boring old scientists.

On top of the mental and physical distress, a woman who successfully starts to withdraw from a drug addiction, will go through withdrawal symptoms, and, depending on the drug, the symptoms can be quite severe. Sometimes the effects can manifest in physical trauma to the person, sometimes mental episodes, certainly there will be emotional highs and lows. It takes a very strong person to struggle through all of that to beat the drug. Moreover, all it takes is one tiny slip up, and she could end up right back in the addiction again.

I don’t think most addicts are ever “cured”… they remain sober, or not. It doesn’t matter if twelve years pass, being in the wrong situation at a time when the willpower is low, and the addictive pattern can come back in full force to haunt the person all over again.

Punish a woman for continuing to use drugs during pregnancy? She’s already punishing herself.

What exactly is the crime? Child-abuse, or more correctly “fetal” abuse? Perhaps delivery of drugs to a minor with the drug delivery occurring through the umbilical cord after the baby is born but before the umbilical cord is cut? (Johnson v. State) Perhaps the woman should be charged with assault with a deadly weapon, namely the drugs. If the fetus dies in a miscarriage, she could perhaps be charged with feticide, but if the child is actually born and then dies, it would clearly be homicide or even possibly murder. Then there’s always contributing to the delinquency of a minor. These all sound rather far fetched to me, but they have all be used to prosecute women in court over the years. (Marshall)

And what exactly should be done to punish her? Throw her in jail where there are no drug treatment programs to help ease her off the addiction and no prenatal care for the baby? Or do you wait and haul her off to jail right after the baby is born—handcuffed, shackled, and still bleeding from the birth? It happened in South Carolina. (Ferguson v Charleston) (Jos)

Fortunately, the prosecution of pregnant women for drug abuse has been found to be “beyond the intent of the law” and in some cases “beyond federal constitutional limits on state power”. That is according to courts in twenty-four states. (Hanigsberg)

I don’t think that there is anyone who wants to argue that it is morally or ethically right for a woman to use drugs knowing she is pregnant. It is unfortunate that in attempting to protect a tiny spark of a life, we forget about the other person in this situation, often just as much a victim as she is the perpetrator.

Unless we, as a society, enable a woman in trouble to get the kind of help she needs—rehabilitation in a drug treatment program that understands women’s addictions, education and empowerment to rise above whatever dragged her into the low spot in her life where she started using drugs, and a commitment to continue to help her even after the birth of her baby–I do not see how punishing the mother helps. It may make those giving out the punishment feel better, but aside from a sense of justice served, how has the situation really improved for the mother or the baby?

Returning to [the anonymous student’s] specific questions, no, I do not believe in creating new punishments for mothers who drank or did drugs up until the end of their pregnancy. Drinking alcohol is not illegal in this country (if you are of legal age), and there are already many laws on the books concerning drug abuse. If the baby is born with trace amounts of drugs and alcohol in its system, the child should be given a complete examination, and it might have to go through detox. I do not see how any punishment of a baby’s mother is good “for the babies sake.” Instead, I see a society that has failed to help one of its own. Separating a baby from its mother is a very serious matter. Child Protective Services should probably be consulted, and they would probably be the most qualified to determine if the mother is physically, mentally, and emotionally fit to continue caring for the child. I think that is adequate, even though it may not be satisfying.

I’m sure we all agree that there is not easy answer to these questions. I certainly respect your thoughts and opinions, and I hope you do the same in return. That is, after all, one of the benefits of living in a democracy that allows free speech.

—Will

References:

  • Ferguson et al v. City of Charleston et al. Plaintiff’s Exhibit 119. U.S. District Court for the District of South Carolina, Charleston Division, Case No. 2:93-2624-1.
  • Hanigsberg, Julia E. and Sara Ruddick, editors. Mother Troubles, Rethinking Contemporary Maternal Dilemmas. Beacon Press. 1999. Retrieved online at http://www.advocatesforpregnantwomen.org/articles/ruddick.htm on May 8, 2008.
  • Johnson v. State. 602 So.2d 1288. Florida. 1992.
  • Jos, Philip H., Marshall Jos, and Martin Perlmutter. “The Charleston Policy on Cocaine Use During Pregnancy: A Cautionary Tale”. Journal of Law, Medicine and Ethics. 23. 120-128. 1995.
  • Marshall, Allison. 1992, 1993, & 1994 Legislative Update in National Association for Families and Addiction Research and Education Update. Chicago. 1993, 1994, 1995.

Kellie Burns replied to me on May 9, 2008 12:05 AM (CC-BY-SA-3.0-US Licensed; read more info):

Will,
Right on, ditto, amen, and praise the lord! I couldn’t have stated the facts any better.

It’s great that you took so much time and effort to explain drug addiction, punishment, etc.

I really feel that there is a big difference between unplanned and planned pregnancy, too. A planned pregnancy will more than likely be a mother who is taking care of her body and avoiding drugs. I remember reading when I was pregnant (unplanned) that the first month and first trimester were very important in regards to the baby’s development. As a matter of fact, some professionals even suggest that women start taking supplements, such as folic acid, even before they become pregnant. (http://www.webmd.com/baby/your-pregnancy-week-by-week-weeks-1-4)

I didn’t know that I was pregnant until my second month, and I probably didn’t start the important vitamins until my third month of pregnancy. It wasn’t because I didn’t care. I was not educated and aware of my situation in time. Women may expose their unborn child to smoke or alcohol without intention. I remember having a beer during my first month, when I didn’t know. I had a beer to ease my fear of boarding a plane flight. Anxiety of the flight is also why I thought my period was missing.

I remain conflicted with where a child’s rights and mother’s rights begin and end. We venture right down the pro-life and pro-choice debate (which I prefer to avoid). How does the saying go: “Your rights end where another person’s nose begins”? (Should I somehow reference or site that quote?) If this saying is true, then I guess the baby doesn’t have any rights. It is just an extension of the mother until the cord is cut and the baby is capable of maintaining life on its own.

I replied to Kellie:

I mentioned before that, to me, the rights of the child should be considered, at least, once it begins to take on aspects of a separate living being. That would appear to happen sometime around the 5th month, during the “quickening”, and certainly by the time the child is young enough to survive on its own as a “preemie”. That doesn’t mean that the mother gives up her rights, but rather that the rights of both need to be considered from then on.

I really do not believe that the government has any right to mandate operations on any human. That harkens back to the types of experimentation done on the Jews and gays in Nazi internment camps. On the other hand, I think that women who are too strung out on drugs to make rational decisions about their sexual activities should be strongly encouraged to volunteer for a reversible form of contraception. That does not mean enrolling them in a trial program or using them as lab rats to test new drugs. It means giving them access to the best type of contraceptive that would work well with a drug user.

I also think that women who use illegal drugs, pregnant or not, should be subject to the regular drug laws. If she is pregnant at the time she is arrested, she should be placed in a facility that is able to provide both prenatal care and rehabilitation programs designed specifically for women. After she gives birth, if she is drug free and her case worker feels she stands a good chance of succeeding as a mother, then she should be released to care for her child. Perhaps “released” is a little too loose of a word. She might do better in some sort of a communal half-way care house with other mothers in similar positions. They could support each other, provide care for each other’s children while some of the mothers take classes to improve their lot in life. The place would allow mother and child to bond, the baby to receive its mother’s milk, and it would keep the woman out of prison and the baby out of foster care. If the woman starts using drugs again, then regular drug laws kick back in, and she goes to prison.

If it is late in the pregnancy, and the mother is not in her right mind due to a drug addiction, then, and only then, it might be time for the government to step in more aggressively. Medical professionals should evaluate the case and see if the child is more at risk remaining inside the mother or being removed by surgery. Then they could proceed in the way that is best for the child, because in this case, the mother has forfeited her rights to care for the child because she can’t even care for herself by then.

At least that’s how I see the separation of the rights of the mother and the child in this case. Other people’s view almost certainly will differ.

—Will

Nicole Zolty replied to me on May 9, 2008 5:02 PM (CC-BY-SA-3.0-US Licensed; read more info):

Will, I appreciate all the points you have brought out. I agree with you on many of them. I am a mother of 3 children and had no idea I was pregnant with the last one until I was about 2 months along. I am a responsible mother who just assumed I was late and run down feeling due to starting a new job and keeping up with the demands of running a house and of course taking care of my 2 sons. I worried so much when I found out I was pregnant due to a small amount of alcohol consumption and some OTC and RX meds I had taken before I knew I was pregnant. My daughter was fine, and I only relay this story to further validate the point you were making about all women of childbearing age refraining from anything that could be considered harmful to a developing fetus/child.

As far as punishment, I know from family experience that drug addiction can be a nasty beast to overcome. My relative has been battling addiction since he was a teen. 25+ yrs later he is still battling it. And yes he has been in many rehabs, and treatment facilities, and has the support and love of his family. He has served jail time also which does get him sober but once he is out he slips.

I do not believe anyone sets out to be a drug addict in life, and little girls do not dream of growing up and doing drugs while they are pregnant. But somehow due to various circumstances that becomes a reality for some, and I do not believe the solution to the problem will be found by punishment.

I replied to Nicole:

Very well said. A 25+ year addiction speaks to the power and control that drugs can influence on someone. Drug addiction of this type is not the sort of thing you see on television. It’s not someone eating a brownie with marijuana every so often with friends. It’s not drinking beer with the buddies on the weekend for fun. It’s not occasionally puffing on a cigarette to calm one’s nerves before an interview. All of those things could, I suppose, lead to a serious addiction, but those are the kinds of things that can probably be stopped because a baby enters the picture.

We are talking about a drug addiction where the person is regularly stealing money to support the habit, possibly endangering his or her life by breaking into places or mugging people, or doing things no sane person would do under normal circumstances. These are the people who do not deserve to continue the human gene pool until they clean up their act. 🙂 They are the type that might need extreme intervention measures.

We are also talking about the people who are somewhere in between the recreational/casual user who can stop anytime and the hardcore addict. These are the people who are functional addicts. They could eventually go either way, or might remain on the same path for a long time. Assuming that such a person can quit at any time is wrong, because, even though they are “functional” they are still addicted. With proper care and plenty of desire on their part, they may be able to win their personal war against drugs. A person who wins that war deserves the right to procreate. That is why I cannot ever agree that permanent sterilization is a viable or necessary option for drug users.

I even question if a person struggling with addiction and consents to permanent sterilization is qualified to make that decision. They may have such low self-esteem and feel so remorseful that they don’t feel worthy of procreating. Later, after they kick the addiction, their whole outlook on life will probably be much brighter, and they might make a wonderful parent—if only they hadn’t agreed to be sterilized.

No. People don’t grow up wanting to be drug users and have to deal with these kinds of problems. Most people don’t even want to think about it long enough to figure out ways to help the people who find themselves in this situation. Instead, it’s “sterilize them!” or “lock them away!” that we hear. After all, once they are locked away, it’s no longer something the person shouting has to think about anymore. Never mind that there is a person locked away behind the bars. A person that just might have been able to be saved if we had tried a little harder, thought a little longer, and cared a little more.

—Will

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3 thoughts on “Drug use during pregnancy: Why punishing mothers who use drugs does not work

  1. A drug alcohol intervention can be of great assistance in helping the man or woman who are blind to their own incredibly self-destructive behavior.
    Interventions can help them begin to make their lives really change for the better.

  2. Indeed, interventions can help. Interventions work for a wide variety of addictions, not just alcohol. Our textbook, in the chapter on "Using Alcohol Responsibly" has this to say on the topic:

    Intervention is a process by which the alcoholic is confronted by a person or persons each describing the "facts" associated with their concern for the alcoholic's drinking problem. Individuals close to the alcoholic (e.g., child, parent, sibling, spouse, friends, employer) can share in this calm, yet truthful process that is intended to assure the alcoholic of their concern for her, but also assertively express the situation as it is. … Intervention actions include developing individual action plans, selecting treatment centers, facilitating an intervention meeting, and facilitating pre-interaction, family, and follow-up meetings.

    <p style="font-size:8pt;">Source: Kolander, Cheryl A., Danny Ramsey Ballard, and Cynthia K. Chandler. <cite>Contemporary Women's Health</cite>. Third edition. 2008. page 320.

    P.S. I did check the author's link on the preceding comment, and it is a legitimate interventionist. I do not know her personally, so I cannot endorse the her or her company, but I see no reason to remove a link that might help someone.

    —Will

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