24 January 2012

Canadian Goverment Please Take Heed


Precursor – long read. I beg, please take the time.
All my comments are in red.
My conclusions and recommendations at the bottom in red.


This is as close to law against pregnant drinking as we are going to get. NO LAW!

Only this…

Mothering and Substance Use:
Approaches to Prevention, Harm
Reduction, and Treatment


In 2009 a national virtual Community of Practice (vCoP) provided the
opportunity for a “virtual discussion” of issues, research, and programming
related to girls’ and women’s substance use in Canada. The goal of the
vCoP was to serve as a mechanism for “gendering” the National Framework
for Action to Reduce the Harms Associated with Alcohol and other Drugs and
Substances in Canada. Participants included planners, decision-makers, direct
service providers, educators, NGO leaders, policy analysts, researchers, and
interested women. The project was sponsored by the British Columbia Centre
of Excellence for Women’s Health (BCCEWH) in partnership with the Canadian
Centre on Substance Abuse (CCSA) and the Universities of Saskatchewan and
South Australia
         
This discussion guide highlights one of the topics explored in the vCoP. It's
purpose is to stimulate further conversation on addressing the needs of
pregnant women and mothers in substance use prevention,
(Want prevention? Make a law against drinking when pregnant and during breast feeding.)
harm reduction, treatment, service system planning, and policy making.

Background

Mothers and pregnant women with substance use problems face
misinformation about womens substance use and addiction, and harsh
multiple barriers in accessing support and treatment services. Fuelled by
media representations, stigma and judgement are ever-present in womens
support networks, service delivery, and program policies. Although there
are welcoming and mother-centred programs across Canada, there are vast
gaps in the availability and accessibility of these services, depending on the
required level of care, mothering status, and the severity of health and social
problems. (After reading this, I am not surprised that the systems we currently have in place are so under-nourished that to fix these above issues would cost millions and millions of dollars. Yet I maintain that still, today, with more and more help-groups popping up all over Canada, the problem of FASD is not getting better. It’s getting worse. So why on Earth is it that the taxpayers money going to more of what isn’t working than than where it should go - prevention, such as a super-heavy TV, billboard, and magazine ad campaigns and/or the threat of prison or losing the child to child services?)
Due to fears of disclosure and limited data, it is difficult to quantify how many
mothers and pregnant women have substance use problems. According to
the 2001 Canadian Community Health Survey, 12% to 14% of women reported
that they had used alcohol in their last pregnancy. A recent American
survey of pregnant women reported that 19% of women used alcohol in their
first trimester, 7.8% in their second trimester, and 6.2% in their third trimester.
Further, of the women who used alcohol in their first trimester, 8% binge
drank, 21.8% smoked cigarettes, and 4.6% used marijuana. Particularly
concerning was the rapid resumption in binge drinking from 1% in the third
trimester to 10% within three months postpartum.
It is estimated that 18% of mothers engaged with the child welfare system
have alcohol problems, and 14% have other substance use problems. It is
also documented that First Nations mothers in Canada lose custody of their
children more than non-First Nations women; First Nations children are placed
in care at a rate of 1 in 10, whereas non-Aboriginal children are placed in care
at a rate of 1 in 200.

Given the risks of heavy substance use to both womens and childrens health,
including the risk of Fetal Alcohol Spectrum Disorder, it is imperative that
continuum of gender-informed services be available to mothers and pregnant
women with substance use problems.

Participants in the virtual Community of Practice (vCoP) discussed four topics
related to mothers and pregnant women with substance use problems: 1)
stigma and public discourse, 2) barriers to treatment, 3) a guiding framework
for practice, and 4) examples of Canadian mother-centred programming. An
overview of these four topics is presented here, followed by a list of discussion
questions and a list of weblinks, both which emerged from this vCoP. The
discussion questions are designed to facilitate the application of a genderbased
analysis to addictions prevention, harm reduction, and treatment
programming and policy as they relate to pregnant women and mothers.

(You can discuss and analyze until you are blue in the face – won’t help – there is no formula to be found just as there is no scientific proof that alcoholism is a disease. Both are dead end streets.)

Stigma and public discourse
Background

Mothers and pregnant women with substance use problems face
multiple barriers in accessing support and treatment services. Fuelled by
misinformation about womens substance use and addiction, and harsh
media representations, stigma and judgement are ever-present in women’s
support networks, service delivery, and program policies. Although there
are welcoming and mother-centred programs across Canada, there are vast
gaps in the availability and accessibility of these services, depending on the
required level of care, mothering status, and the severity of health and social
problems.

Due to fears of disclosure and limited data, it is difficult to quantify how many
mothers and pregnant women have substance use problems. According to
the 2001 Canadian Community Health Survey, 12% to 14% of women reported
that they had used alcohol in their last pregnancy. A recent American
survey of pregnant women reported that 19% of women used alcohol in their
first trimester, 7.8% in their second trimester, and 6.2% in their third trimester.
(To me that means a minimum of 19% of newborns will already be brain-damaged.)
Further, of the women who used alcohol in their first trimester, 8% binge
drank, 21.8% smoked cigarettes, and 4.6% used marijuana. Particularly
concerning was the rapid resumption in binge drinking from 1% in the third
trimester to 10% within three months postpartum.
(To me that means a minimum of 18% of newborns will already be brain-damaged.)
It is estimated that 18% of mothers engaged with the child welfare system
have alcohol problems, and 14% have other substance use problems. It is
also documented that First Nations mothers in Canada lose custody of their
children more than non-First Nations women; First Nations children are placed
in care at a rate of 1 in 10, whereas non-Aboriginal children are placed in care
at a rate of 1 in 200.

Given the risks of heavy substance use to both womens and childrens health,
including the risk of Fetal Alcohol Spectrum Disorder, it is imperative that a
continuum of gender-informed services be available to mothers and pregnant
women with substance use problems.
Participants in the virtual Community of Practice (vCoP) discussed four topics
related to mothers and pregnant women with substance use problems: 1)
stigma and public discourse, 2) barriers to treatment, 3) a guiding framework
for practice, and 4) examples of Canadian mother-centered programming. (#4 scares me a bit because I believe mother-centered programming will flush the idea of laws against pregnant drinking right down the proverbial baby toilet. It is this movement in Canada that is like sandpaper to the fighting unborn fetus. It says, “It’s ok, drink mom drink and kill off my cells.” You won’t care now and after you’ll have plenty of arms holding you and comforting you while the child beside you suffers from FASD.)

Stigma and public discourse

Stigma surrounding women who are pregnant or mothering and using
substances is evident throughout our systems of care and in the public
discourse. Historically, and presently, public discourse has been both blaming
and unsympathetic towards mothers who use substances. Further, mothers
who use substances are deemed solely responsible for their circumstances,
and undeserving of care. Despite national efforts to shift this paradigm
media continue to misrepresent the needs and intentions of mothers
with substance use problems, and propose punitive, over supportive, health2010

(What? Now we can’t even have stigma? I won’t say that addicts are undeserving of care but I will ask, “Just what are the needs and intentions of addicted mothers?” I say hurray for the media. Punitive is the way to go because talking and hugging is not working. Oh yes, there will be a care giver who can give eyewitness testimony that the talk/hug system worked with one client but come on, there are bound to be a few drink/drug quitters. Fact is, the success rate of AA over 1 year is 5% . Curious. That is exactly the number of people who quit alcohol, hard drugs and even smoking, by themselves. So to the few that make it, was it really the help or were they merely spurred into a decision to quit by themselves by taking PERSONAL RESPONSIBILTY. I prefer to think the latter because statistically, the latter is fact.)


Harm Reduction Oriented


In the context of mothering and pregnancy, reducing the
harm of substance use often means attending to women’s
basic needs such as nutrition and housing. Harm reduction
approaches take a pragmatic and compassionate approach to
care. Service providers are willing to discuss goals other than
complete abstinence from all substances (in spite of the known
risks), and consider all aspects of harm. (That’s just ridiculous to me) In this approach,
there is recognition of the interconnectedness of many areas of
women’s lives, such as trauma, mental ill health, and substance
use. Accordingly, engagement in treatment begins with
what is most important and possible for the woman.

(This is just bizarre. All across Canada there are discussions and meetings and meetings of the minds and none of it is working. It’s like the alcoholic that attends AA meetings. Don’t be fooled – they drink – somtimes right after meetings. Talking is really cheap. Law is unbendable and permanent. But in Canada, the fetus has no rights at all. Pregnant women know this. As you’ve read in the previous blog, many US States see with their eyes right through meaningless talk and go straight to the penalties. There is no better stigma than breaking the law. After a pregnant mother’s group, how does anyone know that some of them are not going for some booze, marijuana, or cocaine/heroin. No one knows. A criminal charge cannot be denied after a positive blood test. Many babies can be saved this way. Families would be much more likely to step in. Even the professional working mom’s babies families. That’s right: across the boards of rich and poor, wine and cocaine, groups or no groups, Canada’s response to pre-natal drinking sucks and it is killing babys’ chances at anything valuable in life. Not to mention the billions of dollars pumped out for the lives of current FASD children and adults but also for the mindless studies that, for example, measure how much a pregnant woman can drink. NO DRINKS are safe – why are you still studying that you dummies?


Examples of Canadian Mother-Centred
Programs

While a generic range of treatment services are available to mothers,
these services are not always visible or readily accessible. The National
Treatment Strategy offers recommendations to strengthen available substance
use services and support through five tiers of support and treatment. The tiers
are described as:

Tier 5 - Intensive residential treatment

Tier 4 - Structured and specialized outpatient services

Tier 3 - Acute, proactive outreach and harm reduction services

Tier 2 - Brief support and referral by a wide range of professionals

Tier 1 - Community-based and outreach services


To successfully address the needs of mothers and pregnant women with
substance use problems, we need gender-informed programming and
practices that reflect the guiding framework in all 5 tiers of support and
treatment. The following Canadian examples demonstrate the types of
programming and practices needed at each tier of support and treatment.


Tier 5 – Residential Treatment Programs


There are very few Canadian examples of residential treatment programs that
accommodate mothers with their children. However, in an attempt to address
this limitation of services, some jurisdictions are putting in place supportive
housing options, with links to residential treatment, for pregnant women prior
to delivery, and new mothers and their infants postpartum.


Tier 4 – Structured Outpatient Services

Jean Tweed Centre, Pathways to Healthy Families and MK2,


Toronto, ON

(www.jeantweed.com)

The Pathways to Healthy Families project, initiated in 2002, addresses the
need for building capacity within the system to better identify and serve
women who use substances who are pregnant or mothering young children.
It involves the placement of substance use counsellors in satellite sites across
Toronto, including community health centres, resource centres for young
parents, the shelter system, and Aboriginal services. These counsellors provide
education and support services to women and their children, as well as to
agencies. The focus of the support is to connect women with local resources,
advocate on their behalf, (On behalf of what? – Drinking? Getting caught? Playing the “I didn’t know game?) and link them with parenting and medical care.

Arising out of the Pathways to Healthy Families project,
Mothers and Kids Too (MK2) is a specialized outpatient program
that addresses the needs of mothers who are pregnant and/
or who have children under the age of six. MK2 is a seven week
long, three day a week, format that provides both substance
abuse counselling and parenting support. In this model,
women do not have to choose between their family and
treatment. Emphasis is placed on integrating programming for
parents and children, ultimately supporting early childhood
development and engagement of parents.


Tier 3 – Proactive Outreach and Harm
Reduction Services

Pregnancy Outreach Programs (Canada Prenatal
Nutrition Program)

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Community-based pregnancy outreach programs (POP)
funded across Canada through the Canada Prenatal Nutrition
Program (CPNP) offer drop-in, multi-faceted, prenatal and
postnatal programming to support the overall health of
mothers and their children. Attending to basic needs such as
nutrition, physical health, and safety, POPs work pragmatically
to meet women where they are at and to reduce the harms of
substance use. In many instances, women with substance use
problems may feel safer accessing services through POPs than
asking specifically for addiction treatment services and risk
losing their children. (Drinking when pregnant is by definition in many of the United States as well as Canadian reports and health professionals, as abuse. How could we allow the unborn to baby stay in that situation?)

There are approximately 350 CPNP projects serving over 2,000
communities across Canada, and over 550 CPNP projects in
Inuit and on-reserve First Nation communities.
(And still FASD is growing. Current community centres and prevention strategies are clearly not very effective.)


Tier 2 – Brief Support and Referral by a Wide Range of Professionals

Brief Intervention by Physicians 

Physicians play an important role in both recognizing and
engaging mothers and pregnant women with substance use
problems, and they play a pivotal role in the prevention of
FASD. Given the social stigma and misunderstanding of
this health problem, it is critical that health care providers are
able to ask about substance use in a supportive and nonjudgemental
way. (There is no misunderstanding of this health problem. People in the know should look at that statement and reverse their thinking. Are you going to assume we as a nation are ignorant? I went on a brief hunger strike where more women signed my petition against drinking when pregnant then men did. See: Post 3 - "FAS Chuldrens Brains are Comprimised + Plus Day 4 Hunger Crazyness" - November 2011 on my sidebar.)

The PRIMA (Pregnancy-Related Issues in the Management
of Addictions) project assists physicians in providing care
for pregnant and postpartum women with substance use
problems through continuing education initiatives and webbased
resources on the effects of various substances and
clinical considerations (www.addictionpregnancy.ca).
Physician education has been offered nationally through
a continuing education course on Fetal Alcohol Spectrum
Disorder created by MDcme.ca, a consortium of seventeen
Canadian medical schools and the College of Family Physicians
of Canada (www.mdcme.ca). This curriculum is currently being
updated.
Several provinces have also undertaken educational initiatives
with physicians: for example the ActNow BC Healthy Choices
in Pregnancy initiative worked with physicians to implement
provincial guidelines on screening and discussing alcohol
physicianresources.htm); and Ontario’s Best Start has
developed desk references and related tools for physicians


Do you see what’s going on here? The Canadian government is pumping millions of dollars into aftercare. Prevention comes in the form of voluntary participation. Like AA, volunteering into a program does not stop addictive practice. I’n not writing something I don’t know about. I was once there. An addict of any kind can and will use when the pressure is too much. Even with exercise, good eating and places to go (which are all good), this doesn’t stop drinking and drugging.
In my most guarded opinion the difference makers in the reduction of FASD incidence are: 1 - Canada’s government along with the many other organizations must start treating the growing fetus as a person instead of a thing. 2 – Canadians who have groups that share information need to look at Rational Recovery (RR) as an alternative to the 12-step (religious) program. (See my April 2011 "12 AA Secrets" in 2 blogs.) RR for drug users consist of both REBT and AVRT (no religion but personal responsibility) (See my, "Quotes to Live By," near bottom - also April 2011.), both of which I’ve taught with success as I always pass out slips of paper to participants after the courses I’ve taught. I have yet to receive a negative response to my course content. 3 – A multi-tier law must be made to punish child abusers. I have empathy for all addicted women. I don’t have empathy for child abuse especially when the kid is helplessly unprotected in mom’s tummy. Not to forget, permanent brain damage and the leading cause of mental retardation in North America as the Hon. Dr. Hedy Fry MLA and Canadian Liberal Health Critic can attest to. 4 – Taking on a new mind-set about the women who drink when pregnant. Even the excuse, “I didn’t know it would hurt the fetus,” doesn’t wash. It is not to be an acceptable excuse when everyone knows that drugs kill organs in the body. To think the fetus is completely unaffected is a lying excuse created by selfish drunks. This more extreme idea (reality) is the one that some prevention groups just don't seem to get. So they just wait for aftercare. The government of Canada must make the responsible ruling of penalizing the women who abuse their fetus before another aftercare client is born.
Does a woman care to have a binge on day 36 whereby the development of the baby’s facial features begin to take place. This will produce the four distinct facial deformities associated with the full syndrome. You must keep in mind that also the brain is the first organ to begin development and the last organ to end development.
Does a woman care to have a drink on day 39 as the heart is forming – could lead to Alcohol Related Birth Defects (ARBD). In this case a potentially deadly one.
Does a woman care to have a drink on day  44. Your baby’s brain has differentiated into the three main parts possessed by all human brains: the forebrain, the midbrain, and the hindbrain – leading to Alcohol-Related Neurodevelopmental Disorder (ARND), the most common birth defect.
Does a woman care to have a drink on day 58. On this day the earliest recordable brain waves will occur – leading once again to ARND.
Does a woman care to have a drink on day 113 whereby the baby grows rapidly, with growth setting the stage for development later this month. Your baby’s weight will increase six times during this fourth month of pregnancy. Even then, the baby will only weigh 6 ounces (168 g), not even half a pound. Drinking at this stage produces underweight babies and other complications – the baby could die.
On day 218 - At this point your baby can register information from all five of its senses.
 Every day to a fetus is an important developmental beginning for one process or another. There is no safe drink. I wish women would think about this and I wish the government would take a stand on this by penalizing pregnant drinkers according to their demeanor. Example: A woman who is warned that she is butchering parts of her baby’s growth sequence should be hospitalized and take AVRT from Rational Recovery and her baby, under hopeless circumstances would be ordered into a foster home or childcare services. On the other hand, a woman who seriously wants to quit (after getting caught or outright admitting the need for real help) should be penalized more lightly – example, reporting for drug testing.
It’s been proven that more programs are not working. FASD incidences are only rising. Only in aftercare do we see progress. Nothing before that. I have a safe pregnancy vision I would gladly share with the government should they decide to help me help pregnant moms.

It is time for the government to step in. They have all the evidence they need for the protection of the fetus (once they accept the fetus as a human instead of a thing). When the fetus says, "Speak for me," we really should do just that honorable MLA's of our great, supposed-to-be-safe country. Now let's listen to the fetus. Come up with a strict, fair plan that may possibly hospitalize the helpless moms and that would also show respect for the honest drinking mother by simple mandatory drug testing. None of my requests are out of the bounds of reality. The Safe Pregnancy Vision is in my book.


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