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 women’s 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 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. (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 women’s and children’s 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 women’s 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 women’s and children’s 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)
php)
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
with
pregnant women (www.hcip-bc.org/resources-forpractice/
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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