Abstract
Substance use during pregnancy poses clear risks to children’s healthy development. However, women with addictions face unique barriers to accessing substance abuse treatment and often delay or avoid treatment seeking. The objective of this study was to examine women’s beliefs about the impact of use on the developing baby and to examine the protective behaviors that women with addictions engage in during the period of time between when they first find out they are pregnant and when they begin substance abuse treatment. Semi-structured interviews were conducted with 15 women who were either pregnant or postpartum and who had used illicit substances during pregnancy. All participants were currently receiving inpatient substance abuse treatment services to address their addiction and were asked to retrospectively report on their experiences. Interviews were transcribed, imported into a qualitative data analysis software, and iteratively coded for themes. Women reported being concerned about the impact of substance use on the developing baby, in particular, about the physical and long-term developmental consequences of prenatal exposure. Given these concerns, women described trying to protect the baby from harm on their own, outside of accessing traditional treatment services. They sought information anonymously, increased their engagement in health-promoting behaviors, and decreased their use of alcohol and other drugs. The results suggest that women who use alcohol and other drugs during pregnancy are often motivated to protect their baby from harm and are engaging in harm reduction behaviors prior to accessing treatment services.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
American College of Obstetricians and Gynecologists. Committee on Healthcare for Underserved Women. (2011). ACOG Committee Opinion 473: Substance abuse reporting and pregnancy: The role of the obstetrician-gynecologist. Washington, DC: ACOG.
American Psychiatric Association. (2001). Position statement on care of pregnant and newly delivered women addicts. Arlington, VA: APA.
Behnke, M., Smith, V. C., Levy, S., Ammerman, S. D., Gonzalez, P. K., Ryan, S. A., … Cummings, J. J. (2013). Prenatal substance abuse: Short- and long-term effects on the exposed fetus. Pediatrics, 131(3), e1009–e1024. doi:10.1542/peds.2012-3931.
Boris, N. W. (2009). Parental substance abuse. In C. Zeanah (Ed.), Handbook of infant mental health (3rd ed., pp. 171–179). New York: The Guilford Press.
Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Research and Educational Trust, 42(4), 1758–1772. doi:10.1111/j.1475-6773.2006.00684.x.
Brady, T. M., & Ashley, O. S. (2005). Women in substance abuse treatment: Results from the alcohol and drug services study (ADSS). Substance Abuse and Mental Health Services Administration Office of Applied Studies. Retrieved June 27, 2014, from http://www.drugabusestatistics.samhsa.gov/womenTX/womenTX.htm.
Breckenridge, J., Jones, D., Elliott, I., & Nicol, M. (2012). Choosing a methodological path: Reflections on the constructivist turn. Grounded Theory Review, 11(1), 64–71.
Brendel, R. W., & Soulier, M. F. (2009). Legal issues, addiction, and gender. In K. T. Brady, S. E. Back, & S. F. Greenfield (Eds.), Women and addiction (pp. 500–515). New York: The Guilford Press.
Charmaz, K. (2014). Constructing grounded theory. London: Sage.
Dube, S. R., Anda, R. F., Felitti, V. J., Croft, J. B., Edwards, V. J., & Giles, W. H. (2001). Growing up with parental alcohol abuse: Exposure to childhood abuse, neglect, and household dysfunction. Child Abuse and Neglect, 25(12), 1627–1640. doi:10.1016/S0145-2134(01)00293-9.
Elmir, R., Schmied, V., Jackson, D., & Wilkes, L. (2011). Interviewing people about potentially sensitive topics. Nurse Researcher, 19(1), 12–16.
Eustace, L. W., Kang, D. H., & Coombs, D. (2003). Fetal alcohol syndrome: A growing concern for health care professionals. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(2), 215–221. doi:10.1177/0884217503251704.
Finch, B. K., Vega, W. A., & Kolody, B. (2001). Substance use during pregnancy in the state of California, USA. Social Science and Medicine, 52, 571–583. doi:10.1016/S0277-9536(00)00161-1.
Flavin, J. (2002). A glass half full? Harm reduction among pregnant women who use cocaine. Journal of Drug Issues, 32(3), 973–998. doi:10.1177/002204260203200315.
Flavin, J., & Paltrow, L. M. (2010). Punishing pregnant drug-using women: Defying law, medicine, and common sense. Journal of Addiction Diseases, 292, 231–244. doi:10.1080/10550881003684830.
Friedman, S. H., Heneghan, A., & Rosenthal, M. (2009). Characteristics of women who do not seek prenatal care and implications for prevention. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38(2), 174–181. doi:10.1111/j.1552-6909.2009.01004.x.
Gergen, K. J., Josselson, R., & Freeman, M. (2015). The promises of qualitative inquiry. American Psychologist, 70(1), 1–9. doi:10.1037/a0038597.
Glaser, B. G. (1992). Basics of grounded theory analysis: Emergence versus forcing. Mill Valley, CA: Sociology Press.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded research: Strategies for qualitative research. New York: Aldine De Gruyter.
Grella, C. E., Hser, Y. I., & Huang, Y. C. (2006). Mothers in substance abuse treatment: Differences in characteristics based on involvement with child welfare services. Child Abuse and Neglect, 30(1), 55–73. doi:10.1016/j.chiabu.2005.07.005.
Guttmacher Institute. (2016). Substance abuse during pregnancy: State policies in brief as of March 1, 2016. Retrieved May 6, 2016, from https://www.guttmacher.org/sites/default/files/pdfs/spibs/spib_SADP.pdf.
Hoffman, K. T., Marvin, R. S., Cooper, G., & Powell, B. (2006). Changing toddlers’ and preschoolers’ attachment classifications: The circle of security intervention. Journal of Consulting and Clinical Psychology, 74(6), 1017–1026. doi:10.1037/0022-006X.74.6.1017.
Institute of Medicine (US) Committee on Crossing the Quality Chasm. (2006). Adaptation to mental health and addictive disorders. Washington, DC: National Academies Press.
Janesick, V. (2003). The choreography of qualitative research: minutes, improvisations, and crystallizations. In N. Denzin & Y. S. Lincoln (Eds.), Strategies of qualitative inquiry (pp. 46–79). Thousand Oaks, CA: Sage.
Jessup, A., Humphreys, C., Brindis, D., & Lee, A. (2003). Extrinsic barriers to substance abuse treatment among pregnant drug dependent women. Journal of Drug Issues, 33(2), 285–304. doi:10.1177/002204260303300202.
Knight, K., & Wallace, G. (2003). Where are the children? An examination of children’s living arrangements when mothers enter residential drug treatment. Journal of Drug Issues, 33(2), 305–324. doi:10.1177/002204260303300203.
Lester, B. M., Andreozzi, L., & Appiah, L. (2004). Substance use during pregnancy: Time for policy to catch up with research. Harm Reduction Journal, 1(1), 1. doi:10.1186/1477-7517-1-5.
Lester, B. M., Bagner, D. M., Liu, J., LaGasse, L. L., Seifer, R., Bauer, C. R., & Das, A. (2009). Infant neurobehavioral dysregulation: Behavior problems in children with prenatal substance exposure. Pediatrics, 124(5), 1355–1362. doi:10.1542/peds.2008-2898.
Maxwell, J. C., & Rutkowski, B. A. (2008). The prevalence of methamphetamine and amphetamine abuse in North America: A review of the indicators, 1992–2007. Drug and Alcohol Review, 27, 229–235. doi:10.1080/09595230801919460.
Murphy, J. M., Jellinek, M., Quinn, D., Smith, G., Poitrast, F. G., & Goshko, M. (1991). Substance abuse and serious child maltreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and Neglect, 15(3), 197–211. doi:10.1016/0145-2134(91)90065-L.
Murphy, S., & Rosenbaum, M. (1999). Pregnant women on drugs. New Brunswick, NJ: Rutgers University Press.
O’Donnell, M., Nassar, N., Leonard, H., Hagan, R., Mathews, R., Patterson, Y., & Stanley, F. (2009). Increasing prevalence of neonatal withdrawal syndrome: Population study of maternal factors and child protection involvement. Pediatrics, 123(4), e614–e621. doi:10.1542/peds.2008-2888.
Ondersma, J., Simpson, M., Brestan, V., & Ward, M. (2000). Prenatal drug exposure and social policy: The search for an appropriate response. Child Maltreatment, 5(2), 93–108.
Ostrea, M., Jr., Ostrea, R., & Simpson, M. (1997). Mortality within the first 2 years in infants exposed to cocaine, opiate, or cannabinoid during gestation. Pediatrics, 100(1), 79–83.
Palinkas, L. A., Horwitz, S. M., Chamberlain, P., Hurlburt, M. S., & Landsverk, J. (2011). Mixed-methods designs in mental health services research: A review. Psychiatric Services, 62(3), 255–263. doi:10.1176/ps.62.3.pss6203_0255.
Paltrow, L. M., & Flavin, J. (2013). Arrests of and forced interventions on pregnant women in the United States, 1973–2005: Implications for women’s legal status and public health. Journal of Health Politics Policy Law, 382, 299–343.
Pan, I. J., & Yi, H. Y. (2013). Prevalence of hospitalized live births affected by alcohol and drugs and parturient women diagnosed with substance abuse at liveborn delivery: United States, 1999–2008. Maternal and Child Health Journal, 17(4), 667–676. doi:10.1007/s10995-012-1046-3.
Schilling, R., Mares, A., & El-Bassel, N. (2004). Women in detoxification: Loss of guardianship of their children. Children and Youth Services Review, 26(5), 463–480. doi:10.1016/j.childyouth.2004.02.006.
Shankaran, S., Das, A., Bauer, C. R., Bada, H. S., Lester, B., Wright, L. L., & Smeriglio, V. (2004). Association between patterns of maternal substance use and infant birth weight, length, and head circumference. Pediatrics, 114(2), e226–e234.
Smith, D. K., Johnson, A. B., Pears, K. C., Fisher, P. A., & DeGarmo, D. S. (2007). Child maltreatment and foster care: Unpacking the effects of prenatal and postnatal parental substance use. Child Maltreatment, 12(2), 150–160. doi:10.1177/1077559507300129.
Suchman, N. E., & Pjulo, M. (2013). Introduction. In N. E. Suchman, M. Pajulo, & L. C. Mayes (Eds.), Parenting and substance abuse: Developmental approaches to intervention (pp. xvii–xx). New York: Oxford University Press.
U.S. Department of Health and Human Services. (2013). Results from the 2013 National Survey on Drug Use and Health: Summary of national findings. Retrieved February 26, 2016, from http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf.
Funding
This research was funded by the National Institute on Drug Abuse, NIDA DA035763, the Doris Duke Fellowship for the Promotion of Child Well-Being, and The Center for the Study of Women in Society at the University of Oregon.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Amanda Van Scoyoc, Jill Ann Harrison and Philip A. Fisher declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Van Scoyoc, A., Harrison, J.A. & Fisher, P.A. Beliefs and Behaviors of Pregnant Women with Addictions Awaiting Treatment Initiation. Child Adolesc Soc Work J 34, 65–79 (2017). https://doi.org/10.1007/s10560-016-0474-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10560-016-0474-0