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An Unspeakable Reality

By November 17, 2021No Comments

Being pregnant and using drugs – that does not sound like a problem-free combination, right? And the stigmatization of people who use (illegal) drugs is immense, for women in particular, as it deviates significantly from society’s expectations from a ‘female role’. Drug use during pregnancy has significant negative consequences, both for the expecting mother and the (unborn) child. However, if it is wanted or accepted, pregnancy can also have positive implications on the situation. This article will take a closer look at the reality of pregnant women who are drug consumers – the difficulties they must face and the challenges they must overcome. 

Being pregnant and using drugs – that does not sound like a problem-free combination, right? And the stigmatization of people who use (illegal) drugs is immense, for women in particular, as it deviates significantly from society’s expectations from a ‘female role’. Drug use during pregnancy has significant negative consequences, both for the expecting mother and the (unborn) child. However, if it is wanted or accepted, pregnancy can also have positive implications on the situation. This article will take a closer look at the reality of pregnant women who are drug consumers – the difficulties they must face and the challenges they must overcome. 

Photo by Josh Bean 

Pregnant women who use drugs are in a difficult physical and psychological situation, facing a multiplication of risks for their health, as well as the health of the unborn child. Pregnancy in these cases is often an additional burden in an already complicated and unstable life condition, but it can also give hope for a better future. However, building trust in support systems is often difficult for these women, as they live in circumstances that do not allow them to blindly trust support systems or social workers (Huber, 2017).

First, drug use during pregnancy endangers not only the expectant mother but also her child. In addition to the syndromes, like the respiratory distress syndrome or the NAS (neonatal withdrawal syndrome), the consequences of drug use include malnutrition and growth retardation. According to Rohrmeister and Weninger (2006), drug-using mothers and their infants often receive inadequate medical care during and after pregnancy. Another risk factor for the mother and child can be their – often precarious – socioeconomic status, which can indirectly affect the care and well-being of both. Therefore, to correctly assess the reality of drug-using pregnant women, their social and economic situation must also be considered. According to Kästner et al. (2014), many drug-addicted pregnant women have not completed their school education, and make their living from low paid jobs, prostitution, the resale of illegal drugs, or social welfare. In the study of Kästner et al. (2014), many people were homeless or were living in run-down apartments that would be unacceptable for newborns. In addition, their daily routines were often dictated by obtaining drugs. For women who use illicit drugs, there are additional problems. Their social and economic situation is even more critical than the situation of women who use legal drugs (e.g., alcohol) due to the illegalization of the substance and the associated problems like criminalization (Kröger et al., 2006 & Kästner et al., 2004). It can also be assumed that in addition to generally poor health status and the high risk of infections (e.g. HIV, hepatitis C), many drug users suffer from their ‘social marginalization’, as well as debt, impoverishment, homelessness, prostitution and violence (Tödte et al., 2016). And these factors can have a considerable effect on the course of a pregnancy.

“When drug-addicted women become pregnant, they experience a particular kind of stigmatization.”

It is also important to point out that socioeconomic status and somatic health are not the only difficulties. According to Wimmer-Puchinger (1992), pregnancies of women who do not exhibit drug addiction can also take on a stressful, pathologizing character. Pregnancy can even be perceived as a ‘crisis’ if the preparation of the parents – and especially the mother – is deficient and becoming a mother is perceived more as a burden than a gift. This depends, among other things, on whether and to what extent the pregnancy is desired – but also on the socio-economic and social circumstances in which the expectant mother finds herself. A comparison with the ‘ideal mother’ can also lead to stress and problems if the idea of one’s motherhood deviates considerably from the ideal and the woman feels that she is not living up to the role.

If the pregnant woman is also a drug user she faces even more challenges. When drug-addicted women become pregnant – intentionally or unintentionally – they experience a particular kind of stigmatization. They do not fit the image of a pregnant woman that the general population considers normal and ‘correct’. When women feel the discrepancy, this – combined with the knowledge of their own (past or present) drug use and living situation – can lead to increased feelings of shame and guilt. In addition, feelings of fear are adding up to this as well. In addition to the fear of ‘failing as a mother’ – which many women who are not drug users also exhibit, but which can be heightened in the case of drug users – there is also the fear that the child could be taken away from them by the child protective services after they give birth.

Drug-using women are also exposed to other factors that can put a strain on the psyche. Many women have experienced or continue to experience frequent physical and sexual violence, and the trauma resulting from these experiences are usually not addressed. Many women also have comorbid somatic or mental health conditions (e.g., depression or anxiety disorders). These are not always a consequence of substance use but are often also the result of a life that has become extremely stressful and burdensome due to poverty, violence, and lack of basic needs such as sleep and nutrition (Tödte et al., 2016).

“Many drug-using women also perceive a child of their own as a beacon of hope and as a chance for a better life.”

Furthermore, drug-using woman experience pronounced doubts about their parenting skills more often and are more socially isolated and they are also burdened – to a greater extent than non-addicted mothers – by difficult external life circumstances, as described above (Kröger et al., 2006). It can therefore be assumed that drug-using women are often under a particular psychological and physical stress that exceeds the bearable maximum for mothers to be (Tödte et al., 2016).

However, many drug-using women also perceive a child of their own as a beacon of hope and as a chance for a better life. On the other side exist their feelings of guilt and fear about harming the child through drugs or imposing a precarious living situation on it. But abortions are rare, considering the difficult situations the women find themselves in, which could be explained by their hope for a new chapter and desire for a good and healthy relationship in their life (Kästner et al., 2004). Sadly, due to the many external and internal demands and expectations, women are often overwhelmed, and collapse under pressure. Facing mostly unfulfillable expectations and the feeling of helplessness, many fall back into old patterns of behaviour that are harmful to the fetus and themselves (Kästner et al., 2004).

All in all, the incompatibility of pregnancy and drug use seems to be due to not only the use and behaviour of the users but also to the circumstances in which they find themselves. Changing these circumstances and reducing the stigma could help to improve the situation of expectant mothers in the long term and possibly help more women to quit excessive drug use. Measures would not only help the mothers but also ensure that more children are brought up in safe and secure environments and experience fewer damaging experiences for their health and psyche. <<

References

-Huber, G. (2017): Schwangerenbetreuung bei Drogenkonsum. In: L. Gortner & J. W. Dudenhausen (Hrsg.): Betreuung drogenabhängiger Schwangerer und ihrer Neugeborenen (S. 39–42). Springer Medizin Verlag.
-Kästner, R., Härtl, K., & Stauber, M. (2004): Drogen und Arzneimittelabusus in der Frauenheilkunde. In: Der Gynäkologe, 37(11), 1037–1049.
-Kröger, C., Klein, M., & Schaunig, I. (2006): Sucht und elterliche Stressbelastung: Das spezifische Belastungserleben in der Kindererziehung von alkoholabhängigen Müttern und substituierten opiatabhängigen Müttern. In: Suchttherapie, 7(2), 58–63.
-Rohrmeister, K., & Weninger, M. (2006): Neugeborene drogenabhängiger Mütter. In: Monatsschrift Kinderheilkunde, 154(1), 79–89.
-Tödte, M. (2014): Schwangerschaft und Mutterschaft bei jungen, traumatisierten, drogenabhängigen Frauen: Schwangerschaft und Mutterschaft bei jungen, traumatisierten, drogenabhängigen Frauen. In: Trauma & Gewalt, 8(3), 232–238.
-Jacob, J. (Hrsg.) (1997): Drogengebrauch und Infektionsgeschehen (HIV/AIDS und Hepatitis) im Strafvollzug. Dt. AIDS-Hilfe e.V.
-Wimmer-Puchinger, B. (1992): Schwangerschaft als Krise. In: Schwangerschaft als Krise (17–29). Springer Berlin Heidelberg.

Pregnant women who use drugs are in a difficult physical and psychological situation, facing a multiplication of risks for their health, as well as the health of the unborn child. Pregnancy in these cases is often an additional burden in an already complicated and unstable life condition, but it can also give hope for a better future. However, building trust in support systems is often difficult for these women, as they live in circumstances that do not allow them to blindly trust support systems or social workers (Huber, 2017).

First, drug use during pregnancy endangers not only the expectant mother but also her child. In addition to the syndromes, like the respiratory distress syndrome or the NAS (neonatal withdrawal syndrome), the consequences of drug use include malnutrition and growth retardation. According to Rohrmeister and Weninger (2006), drug-using mothers and their infants often receive inadequate medical care during and after pregnancy. Another risk factor for the mother and child can be their – often precarious – socioeconomic status, which can indirectly affect the care and well-being of both. Therefore, to correctly assess the reality of drug-using pregnant women, their social and economic situation must also be considered. According to Kästner et al. (2014), many drug-addicted pregnant women have not completed their school education, and make their living from low paid jobs, prostitution, the resale of illegal drugs, or social welfare. In the study of Kästner et al. (2014), many people were homeless or were living in run-down apartments that would be unacceptable for newborns. In addition, their daily routines were often dictated by obtaining drugs. For women who use illicit drugs, there are additional problems. Their social and economic situation is even more critical than the situation of women who use legal drugs (e.g., alcohol) due to the illegalization of the substance and the associated problems like criminalization (Kröger et al., 2006 & Kästner et al., 2004). It can also be assumed that in addition to generally poor health status and the high risk of infections (e.g. HIV, hepatitis C), many drug users suffer from their ‘social marginalization’, as well as debt, impoverishment, homelessness, prostitution and violence (Tödte et al., 2016). And these factors can have a considerable effect on the course of a pregnancy.

“When drug-addicted women become pregnant, they experience a particular kind of stigmatization.”

It is also important to point out that socioeconomic status and somatic health are not the only difficulties. According to Wimmer-Puchinger (1992), pregnancies of women who do not exhibit drug addiction can also take on a stressful, pathologizing character. Pregnancy can even be perceived as a ‘crisis’ if the preparation of the parents – and especially the mother – is deficient and becoming a mother is perceived more as a burden than a gift. This depends, among other things, on whether and to what extent the pregnancy is desired – but also on the socio-economic and social circumstances in which the expectant mother finds herself. A comparison with the ‘ideal mother’ can also lead to stress and problems if the idea of one’s motherhood deviates considerably from the ideal and the woman feels that she is not living up to the role.

If the pregnant woman is also a drug user she faces even more challenges. When drug-addicted women become pregnant – intentionally or unintentionally – they experience a particular kind of stigmatization. They do not fit the image of a pregnant woman that the general population considers normal and ‘correct’. When women feel the discrepancy, this – combined with the knowledge of their own (past or present) drug use and living situation – can lead to increased feelings of shame and guilt. In addition, feelings of fear are adding up to this as well. In addition to the fear of ‘failing as a mother’ – which many women who are not drug users also exhibit, but which can be heightened in the case of drug users – as there is also the fear that the child could be taken away from them by the child protective services after they give birth.

Drug-using women are also exposed to other factors that can put a strain on the psyche. Many women have experienced or continue to experience frequent physical and sexual violence, and the trauma resulting from these experiences are usually not addressed. Many women also have comorbid somatic or mental health conditions (e.g., depression or anxiety disorders). These are not always a consequence of substance use but are often also the result of a life that has become extremely stressful and burdensome due to poverty, violence, and lack of basic needs such as sleep and nutrition (Tödte et al., 2016).

“Many drug-using women also perceive a child of their own as a beacon of hope and as a chance for a better life.”

Furthermore, drug-using woman experience pronounced doubts about their parenting skills more often and are more socially isolated and they are also burdened – to a greater extent than non-addicted mothers – by difficult external life circumstances, as described above (Kröger et al., 2006). It can therefore be assumed that drug-using women are often under a particular psychological and physical stress that exceeds the bearable maximum for mothers to be (Tödte et al., 2016).

However, many drug-using women also perceive a child of their own as a beacon of hope and as a chance for a better life. On the other side exist their feelings of guilt and fear about harming the child through drugs or imposing a precarious living situation on it. But abortions are rare, considering the difficult situations the women find themselves in, which could be explained by their hope for a new chapter and desire for a good and healthy relationship in their life (Kästner et al., 2004). Sadly, due to the many external and internal demands and expectations, women are often overwhelmed, and collapse under pressure. Facing mostly unfulfillable expectations and the feeling of helplessness, many fall back into old patterns of behaviour that are harmful to the fetus and themselves (Kästner et al., 2004).

All in all, the incompatibility of pregnancy and drug use seems to be due to not only the use and behaviour of the users but also to the circumstances in which they find themselves. Changing these circumstances and reducing the stigma could help to improve the situation of expectant mothers in the long term and possibly help more women to quit excessive drug use. Measures would not only help the mothers but also ensure that more children are brought up in safe and secure environments and experience fewer damaging experiences for their health and psyche. <<

References

-Huber, G. (2017): Schwangerenbetreuung bei Drogenkonsum. In: L. Gortner & J. W. Dudenhausen (Hrsg.): Betreuung drogenabhängiger Schwangerer und ihrer Neugeborenen (S. 39–42). Springer Medizin Verlag.
-Kästner, R., Härtl, K., & Stauber, M. (2004): Drogen und Arzneimittelabusus in der Frauenheilkunde. In: Der Gynäkologe, 37(11), 1037–1049.
-Kröger, C., Klein, M., & Schaunig, I. (2006): Sucht und elterliche Stressbelastung: Das spezifische Belastungserleben in der Kindererziehung von alkoholabhängigen Müttern und substituierten opiatabhängigen Müttern. In: Suchttherapie, 7(2), 58–63.
-Rohrmeister, K., & Weninger, M. (2006): Neugeborene drogenabhängiger Mütter. In: Monatsschrift Kinderheilkunde, 154(1), 79–89.
-Tödte, M. (2014): Schwangerschaft und Mutterschaft bei jungen, traumatisierten, drogenabhängigen Frauen: Schwangerschaft und Mutterschaft bei jungen, traumatisierten, drogenabhängigen Frauen. In: Trauma & Gewalt, 8(3), 232–238.
-Jacob, J. (Hrsg.) (1997): Drogengebrauch und Infektionsgeschehen (HIV/AIDS und Hepatitis) im Strafvollzug. Dt. AIDS-Hilfe e.V.
-Wimmer-Puchinger, B. (1992): Schwangerschaft als Krise. In: Schwangerschaft als Krise (17–29). Springer Berlin Heidelberg.
Anne Sophie Giacobello

Author Anne Sophie Giacobello

Anne Sophie (1996) specialised in Brain and Cognition in her third year of psychology. She likes thinking about the connections between psychology, politics and society and never leaves the house without her journal, a pen and her current read.

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