Innovative programs in Indian country have proven that love and courage can go a long way in healing pregnant women suffering from substance addictions and helping them save their babies from the short- and long-term consequences of prenatal exposure to drugs and alcohol.
“These moms really love their babies, they just can’t fight this disease alone,” said Julie Williams, White Earth Nation, program manager for the tribe’s MOMs (Maternal Outreach and Mitigation Services) program in Naytahwaush, Minnesota.
Because of that love, women somehow find the courage to change. It’s scary, Williams explained, to come forward. Women risk losing their other kids and potentially expose themselves to yet more criticism and shame in their communities. They also face the possibility that their family might reject them—either because they are using or because they are going to stop using when no one else wants to, said Wrapped In Hope’s Caroline McDonald. “We have one patient now in a very loving family, but moving out in the middle of her pregnancy because everyone else in her home is continuing to use. She knows she can’t be successful in her pregnancy or in her goals by continuing in that environment. It takes an incredible amount of bravery to do that.”
Or it could land them in jail. Only one state, Tennessee, has passed a law making it a crime to use drugs during pregnancy (that law expired in June), but the Supreme Courts of Alabama and South Carolina have ruled that prenatal drug use is criminal child abuse. In 23 states and the District of Columbia, pregnant women who use drugs have been prosecuted as definitions of child abuse have been expanded to include prenatal drug use, according to the Guttmacher Institute. These practices continue in the face of research that shows criminalization of prenatal drug use is not an effective deterrent and that the threat of incarceration causes some women to avoid getting prenatal care for what are invariably high-risk pregnancies, despite findings by the American College of Obstetricians and Gynecologists that prenatal care “greatly reduces the negative effects of substance abuse during pregnancy.” Both the ACOG and the American Medical Association have come out against criminalizing prenatal drug use.
These innovative programs work because they are comprehensive. They offer not only addictions counseling and treatment but also mental health and medical services, group counseling and help with housing and food stamps. They liaise with tribal and/or state and local child protective services, law enforcement and schools. They provide services for the woman’s other children, for her partner and oftentimes for her extended family.
Wrapped in Hope is a collaboration between St. Luke Community Healthcare, Providence St. Joseph Medical Center, the Confederated Tribes of the Salish and Kootenai of the Flathead Reservation Health Department and Lake County Public Health, according to Shanley Nicolai, a licensed addictions counselor with the program. Instead of a woman being referred for counseling, say, to another facility with a long wait list, she can see her therapist at the same time and in the same place as she sees her obstetrician and her addictions counselor.
“With having someone in the clinic the doctor can say, ‘Let me introduce you to … she’s just down the hall,’ and you have what we call a warm handoff. So the client doesn’t feel like they’re having 15 different appointments at 15 different places. It’s almost like a one-stop shop and all the providers come to you and provide you with care.” And providing multiple services in one facility that other people also use for health care helps avoid the stigma of being a drug addict.
Clients can also get their medications at the facility. Medication-assisted treatment for opioid addiction is strongly preferred to letting a pregnant woman detox, said Williams. “When the mom goes through withdrawals the baby goes through that 100 time worse than the mom. People don’t see that because the baby’s in the belly. We only see the mom and we judge them and we criticize them and say, how bad are you? We don’t think about how much pain that mom is going through. Addiction is a disease, but a lot of people don’t see it that way.”
Wrapped In Hope and the MOMs program were both started recently in response to the rising number of babies born with substances in their systems and to a crisis in day care when providers were seeing an exponential increase in children with attention and other serious behavioral disorders.
Behavior Management System’s Full Circle program in Rapid City, South Dakota, has been around for a couple of decades, said JoSee Suess-Carlin, addictions program director. The program, which was started because of concerns about women who were drinking during their pregnancies, begins with a 45-day residential treatment regime and continues with a lower intensity outpatient program to help women make changes over time as they discover previously-unidentified issues.
“As the women are getting clean and sober and discovering the reality of who they are and the things they’ve experienced day to day they may discover mental health issues. We will work with them on mental health issues, past trauma, depression, anxiety, grief and we also have a mental health staff at BMS who can work with them,” Suess-Carlin said. Medical staff help manage medication and treat other illnesses. “We work to get people back on track medically. We have people with medical issues that have never been addressed or haven’t been addressed in a long time, like diabetes,” she said.
Seeing addiction as a disease, and treating women in a non-judgmental way, are critical to the success of these programs. Women suffering from addiction, particularly pregnant women, are judged harshly in their communities and by pretty much everyone they come in contact with. The successful treatment programs offer non-judgmental individualized help in a physically and emotionally safe environment. Suess-Carlin said: “We walk with the women where they’re at and that’s one of the most powerful things about our program.”
Williams said the MOMs program gets calls for help from all over the country. “We want people to realize that this is a disease that affects everybody, not just Native communities. There should be programs like this everywhere.” The medical, mental health, law enforcement and child protection communities in other places need to work together and make it easier for substance using pregnant women to get comprehensive help for the range of challenges they will face as they strive to create healthier lives for themselves and their families, she said.
Tribal representatives are invited to attend the Earth Moon and Sacred Stars Maternal and Child Health Institute Symposium scheduled for May 3-4 in Mahnomen, Minnesota. The symposium will feature presentations by Julie Williams and Jennifer Giroux, IHS, and will explore best practices programs related to prenatal exposure to substances, nutrition and traditional parenting. Each participant will receive a workbook to facilitate action planning for the specific issues facing his or her community, according to Vanessa Tibbitts, Oglala Lakota, American Indian Public Health Resource Center at North Dakota State University. The symposium is a joint presentation of the White Earth Nation, the March of Dimes, the North Dakota Department of Health and the AIPHRC. Travel scholarships are available. Contact Shelly S. Davis, firstname.lastname@example.org, 701-231-6269.