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Drug use in pregnancy
Obviously, using heroin whilst pregnant isn't a good idea. But this isn't normally a choice, it's a matter of a women becoming pregnant whilst already addicted. People’s attitudes towards you will change, as all of a sudden it's not just you - you have another person wrapped up inside your body, being affected by everything you do. So what can you do next? The first thing you must do, is contact a specialist midwife, GP or your local Drug Dependency/Counselling Center. If you are addicted to drugs and trying to get pregnant, seek help first. Once you are pregnant you won't be able to withdraw from the drugs until after the birth, meaning that your baby will also have to go through a withdrawal. So don't be selfish - get clean first and then you can look forward to having a healthy pregnancy and baby. Ask your doctor for advice and a possible referral to a treatment program.
Everything you do can have an effect on your baby - that is why it is important to call your doctor or midwife as soon as you think you might be pregnant and then to continue with regular visits once its confirmed. You should tell the medical staff about your drug or alcohol use on your first appointment. They will then be able to help you and work out the best form of care for you and your baby.
What is prenatal care and when should I see a doctor? You will usually be seen for your first prenatal visit at 10-12 weeks from your last menstrual period. A prenatal plan encompasses the time from before your baby is conceived to after your baby is delivered, and deals with medical and psychosocial issues of the entire family.
If you are pregnant or plan to become pregnant, you should first find a skilled medical provider who will help you achieve the best possible outcome for your pregnancy. Early and consistent prenatal care decreases both the risk of infant death and complications of pregnancy such as premature delivery. Health Center physicians are fully trained to provide family care during and after this life-changing event.
The first prenatal visit is the longest, usually lasting up to one hour. A full history and physical, plus lab tests will be done. A special pregnancy risk assessment is also done at this time and the due date determined. Normally, you will see your health care provider once a month until 32 weeks. From 32 to 36 weeks, your visits become weekly until you deliver the baby. Your health care provider will check your baby's growth and heart rate and will also care for your well being at the prenatal visits. Families are encouraged to participate.
Pregnancy and the Foetus
The first three months of pregnancy are the most wearing. You might feel sick, tired and bloated, and all this isn't helped if you haven't made up your mind whether to keep going with the pregnancy or have it terminated.
Added to that, pregnancy often causes upsets and difficulties in relationships, whether with sexual partners, family or friends. All these pressures make it more difficult than usual to come off drugs.
What are the risks? Women who use often find that they have a perfectly fine pregnancy and there’s nothing wrong with the baby.
The most sensitive time is between three weeks and three months, when the foetus is developing from a blob into a little person. Using at this stage may make a miscarriage more likely.
Being pregnant puts an extra strain on your liver and kidneys, because there’s the waste produce of another person being put through them. Street drugs are often cut with bad substances that also have to be filtered through the same systems. So your poor old innards are suffering strain from two sources, and they may kick up a bit of a fuss about it.
The drugs you’re on might induce an early labour. Using heroin (or any physically addictive drug) whilst pregnant, means that your baby will be born dependent and will go into withdrawal after birth. Children born to addicted mothers are at greater risk of SIDS (Sudden Infant Death Syndrome) as well.
Being pregnant means you need to eat for two. If you’re using drugs which lessen your appetite, that little foetus will be fighting for a decent share of the food, so your health will deteriorate.
You may also have problems going into labour. Opiates are painkillers and your body will be used to them, so if they give you painkillers you might find them worse than useless. But an epidural, which is an injection straight into your spine, should work.
You may have problems going into withdrawal while you’re in labour, which will make the labour pains seem twice as bad. Also, if the doctor or midwife isn't aware of your habit and gives you narcotics, this could combine with what you’ve already had and cause an overdose. Obviously you can trust them, so it's better to tell people helping you about your drug use.
Stopping during pregnancy
Some sources say that pregnant women should not be detoxified from opiates because of the increased risk of spontaneous abortion or premature delivery; rather, treatment with methadone is strongly advised. Although infants born to mothers taking prescribed methadone may show signs of physical dependence, they can be treated easily and safely in the nursery. Some babies may have to stay in hospital for the detox. In these circumstances you would be able to stay with your baby on the postnatal ward so that you could be close to each other and it would take around 7-10 days. Research has demonstrated also that the effects of in utero exposure to methadone are relatively benign. The decision of whether to change over from heroin to methadone is a difficult one. To obtain methadone ask your GP or Drug Dependency Unit. Methadone means you get regular legal supplies, so there’s less stress on you, your body and the growing baby, and you’ll have more money to keep yourself healthy and prepare for the baby.
On heroin your body (and baby) are getting irregular doses, so you are going up and down. Using Methadone means that you will have a controlled, steady dose. You will feel the same all the time, no highs and no lows. This is obviously better for the baby. Also Methadone has no reported cases of birth defects and research has demonstrated that the effects of in utero exposure to Methadone are relatively benign. Babies are normally born a normal size, unlike when the mother has used heroin. This is largely contributed to the fact that heroin users don't eat properly, out of having no money, laziness or out of non-hunger. But on methadone your hunger should return and you will be able to eat properly. It also means that you will be able to afford to eat properly, as you won't be spending money on gear.
But flip the coin and it's not so good. It's more difficult to withdraw from methadone and it means that you have to inform the medical authorities that you're on drugs. In the UK this will mean that you will be put on the Home Office register of drug addicts. You will also give birth to an addicted baby, meaning that it will need to go through withdrawal. But as this is the same using heroin, methadone is obviously the better alternative.
However, it is possible to reduce your methadone intake throughout the pregnancy and be able to be clean by the birth. This can't happen to everyone, but is possible and many people have managed it. Failing that, it is said that most mothers who can get down to a dose of 20 mils or less, have given birth to non-addicted babies. There is no guarantee for this, as it has been known for people that use a lot of gear or methadone every day to have non-addicted babies, same as there has been people that have gotten down to 10 mils or less, and have an addicted baby. You never can tell. But the main point to consider, if you are pregnant, is that if you get onto methadone and reduce yourself to less than 15 mils per day, the odds are in your favour for having a perfectly healthy, non-addicted baby. It's worth giving it a go, isn't it?
You might be getting good care and support from a Drug Dependency Unit or a doctor that knows you are on drugs. If you are not, shop around and talk to drug agencies, to find someone to help you. Research is being carried out for the use of Buprenorphine during pregnancy and this should be available in the near future.
DO NOT ATTEMPT A DETOX WHILST PREGNANT WITHOUT TALKING TO YOUR GP, A SPECIALIST MIDWIFE OR A DRUG DEPENDENCY/COUNSELLING UNIT – THIS COULD BE FATAL TO THE UNBORN BABY
Breast-feeding
If you have been taking Methadone or heroin whilst you were pregnant, your baby will probably have some withdrawal symptoms. You can help him feel better by breastfeeding, as the traces of Methadone in your milk will ease his symptoms, in the same way that Methadone works for you. You don't need to worry about reducing him off the Methadone in the milk (unless you want to stop breastfeeding immediately), as babies naturally do this as they get older. Around the time that your baby starts eating food, he will reduce the amount of milk that he drinks and eventually he will stop breastfeeding all together.
Drugs and Medicines in Breast Milk There are 3 facts about drugs and human milk:
Nursing mothers should not be using alcohol or drugs such as: Amphetamines (Meth), Crystal, Speed, Uppers, PCP/Angel Dust, Marijuana, Cocaine, Heroin, LSD, T's, Blues, Mescaline, Peyote. Alcohol goes into a mother's milk very quickly. It is not safe for a nursing mother to breastfeed her baby the morning after she has drunk alcohol.
Another group of drugs that should be avoided because they can suppress milk production are: ergotamines (for migraines), birth control pills with a high estrogen content (most birth control pills are OK), vitamin B6 (pyridoxine) in large doses, and many antidepressants.
Caffeine does not seem to bother most nursing babies if the mother takes in less than 2 cups of coffee or 2 Cokes a day. Larger amounts may make your baby wakeful and crabby.
Some nursing mothers who smoke cigarettes have a decreased milk supply. Waiting as long as possible between smoking and nursing helps. Babies get nicotine when they breathe in second-hand smoke. Ask family members and visitors to smoke outside.
COMMON SYMPTOMS OF INFANT WITHDRAWAL
Withdrawal often develops after the first 24 hours of life. The babies are agitated and irritable, difficult to settle and suck poorly. They often have diarrhoea and scratch themselves; hiccups and coughs sometimes occur. Withdrawal can be so severe that the babies have convulsions if not treated. In about 75% of cases the only treatment which is required is supportive care, that is, soothing the baby by bathing more often and feeding frequently. The baby is wrapped tightly in blankets to make him/her feel secure. If the irritability is extreme the baby may need medication.
If you have been using heroin during your pregnancy, you should inform your midwife or doctor so that the baby can be closely monitored during the first week or two after birth. They will be able to help the newborn get through the withdrawal symptoms by giving the child a reducing dose of medication (morphine). Unless the child has presented with other problems and needs to go into a special baby unit, you should be able to stay with them in the hospital, with them at your bedside or even take them home with a prescription for the medication they need.
If you haven't told any of the medical staff and you take the baby home and they start withdrawing, it would be best for you to take them back to the hospital to get help. Remember how bad you feel when withdrawing - do you really want to put your baby through that? They can be made comfortable and be closely monitored in the hospital. The hospital will put your baby first and wont contact Social Services unless there are other problems, either way your child wont be taken off you just because you are an addict. However, if you still decide not to get any help for your baby, then you could help relieve some of their discomfort with the following:
Remove extra covers and don't swaddle baby OR Put baby in nappy and vest only OR Lower room temperature
FRANTIC SUCKING OF FISTS The baby may need feeding, check to see if he/she is hungry.
Give the baby clothes with sewn-in mitts or scratch mitts to prevent him/her hurting his/her skin. This helps reduce breaks in the skin and possible infection.
Give the baby a dummy to suck. A dummy is comforting, but don't give it this instead of a feed.
IRRITABILITY Some babies are irritable and tense from time to time – bathe the baby in warm water. Dry him/her gently. Warm water and gentle drying are soothing.
TREMBLING Change his/her position frequently. Put baby on a soft blanket or sheepskin. This will help his/her skin from becoming sore. Cut down light and noise in the room, as this may irritate the baby.
FITS, CONVULSIONS Lay the baby in a supervised place of safety on a soft surface and away from the risk of falling or being injured in any way. This reduces the possibility of the baby breathing in vomit and choking. Call for medical help immediately.
VOMITING Feed baby slowly if he/she starts to gulp at the milk. Clean the skin area after the baby has been sick. Stomach contents contain acid which can irritate the skin.
If the baby is bringing back food, lie him/her on his/her side to prevent him/her breathing in the vomited food. This prevents choking.
POOR FEEDING If the baby is sucking poorly, support his/her chin and both cheeks to increase his/her sucking ability. A nurse or midwife should be able to show you this technique. This will encourage your baby to suck better. Seek medical help if the baby does not respond to this.
HIGH PITCHED CRY Soothe your baby by holding him/her close to your body. A baby sling may be useful to help soothe your baby. This will help as it will make him/her feel safe.
INABILITY TO SLEEP Cut down light and noise in the room. As this will irritate the baby.
Don't jiggle the baby too much. This may cause the baby to become agitated.
Humming and rocking gently may be soothing. All babies like to hear their mothers voice, especially when gently singing. It makes them feel safe.
SNEEZING, NASAL STUFFINESS, TROUBLE BREATHING Make sure the baby’s nose is not blocked by the gentle use of cotton wool buds. Babies can only breathe through their nose and if it's blocked they will have trouble breathing.
Don't wrap the baby too tightly in blankets as they can restrict his/her chest movement. Babies lungs are tiny, if you restrict them the baby will become distressed.
If the baby seems to be panting most of the time, even when he/she is asleep CALL FOR MEDICAL HELP. The baby may be having a reaction to the drug withdrawal.
If the baby seems pale or his/her skin color seems to become grey or blue CALL FOR MEDICAL HELP. These symptoms may occur due to drug withdrawal, but may also be related to other illnesses, therefore don't leave it too long before you call for medical help.
IF ANY OF THESE SYMPTOMS PERSIST AFTER YOU HAVE TRIED THE RECOMMENDATIONS, CONTACT YOUR DOCTOR OR MIDWIFE IMMEDIATELY.
Many people wonder which medications are safe when they are pregnant. Only a few medications have been approved for use when you are pregnant. Many other ones can be safe if they are used with caution. Follow these common rules for using medications during pregnancy:
What about smoking, alcohol, street drugs & caffeine? Smoking If you are trying to get pregnant, quit smoking first. If you are already pregnant, try to stop. Smoking is one of the worst things you can do when you are pregnant and causes more problems than even most drugs do. Smoking affects every aspect of pregnancy including fertility, conception, development of the fetus, labor, and growth during childhood. The main result of smoking during pregnancy is low birth weight. Studies show that children who are born with low birth weight are most often shorter, have more breathing problems and have more trouble in school than children of non-smoking mothers. You also have a 25% greater chance of having a miscarriage, premature birth, or stillbirth. Cigarette smoking hinders the blood supply to the fetus, and less oxygen and food are supplied through the placenta. Several toxins enter the maturing baby's blood including carbon monoxide, nicotine and cyanide. A higher amount of Sudden Infant Death Syndrome or "crib death" is also linked to mothers who smoke.
Alcohol When a woman drinks alcohol while she is pregnant, she is putting herself and her baby at risk for fetal alcohol effect and fetal alcohol syndrome most often known as FAS. FAS is one of the top three causes of birth defects and affects about one in every 750 babies. The alcohol passes through the placenta and into the fetus' blood. As the fetus liver can not process the alcohol very well, it remains in its system long after the mother's body has gotten rid of it. FAS can cause low birth weight, deformities of the limbs, joints, fingers and face, small head circumference, central nervous system dysfunction and heart defects.
The symptoms of FAS will sometimes not appear until the child is a teen. The child suddenly becomes hyperactive or has learning and perceptual problems. Physical problems may begin, which can include chronic ear infections, hearing loss and dental and vision problems. It is not known how much alcohol is safe but an average of one to two drinks daily has been linked to these problems. Therefore, a woman should refrain from drinking when she is pregnant, while she is trying to conceive, and when she is breast feeding her baby.
Street Drugs Recreational drugs such as marijuana, LSD, and speed are not safe to take when you are pregnant. Though you may have used them without harmful effects before, it will be risky to use them while you are pregnant or nursing your baby. One of the street drugs often used is cocaine. Whether smoked, snorted, or shot, it quickly gets into your bloodstream and crosses the placenta into your baby's blood. The placenta or afterbirth has the important job of bringing oxygen and nutrients to your growing baby. Your high may last up to thirty minutes. But your baby is not mature and the effect of the drug in his system may last as long as five to six days. Cocaine and amphetamines cause your blood vessels to constrict or tighten, and your uterus or womb to contract. This makes the blood flow that goes to your baby smaller. The mixture of the tight blood vessels and the contracting of the uterus may cause the placenta to be pulled away from the wall of the uterus. This is a very grave and unsafe and may cause you or the baby to die. Other problems that may occur are bleeding or spotting at any point when you are pregnant. If contractions or cramping remain, you may lose your pregnancy. If this happens early while you are pregnant, you may have a miscarriage. If this happens before the baby is ready to breathe on his own, your baby may be born too early. The baby would need to stay in a special care nursery and would require a great deal of care. Use and abuse of street drugs can increase the risk of miscarriage, premature separation of the placenta, premature birth, and small babies. Some babies may die while inside the uterus, and others may die after they are born. The babies who survive may have lasting physical, behavioral, and emotional problems.
Caffeine Coffee, tea, chocolate, some cola drinks, and some medications contain caffeine. Animal experiments have shown that high doses of caffeine may cause birth defects in rats. There are no proven cases in humans. There are some reported cases (not scientifically proven through research, however) of increased miscarriages. It's most often best to reduce the amount of caffeine you consume to low levels while you are pregnant.
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The main point to remember is that the minute you find out your pregnant, contact your GP or Drug Dependency/Counselling center to discuss the situation. Many hospitals have specialist midwives that you can contact with regard to drug use in pregnancy.
If you decide to withdraw, DO NOT attempt it without first seeking professional advice. Remember that this may be fatal to the unborn child. Consider going onto methadone first as no-one wants to miscarry and this is the best way to ensure that your baby is safe and has a better chance than on heroin.
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Last updated: 16 March 2006 |
Drugs,
alcohol, and tobacco can have harmful effects on your body and mind. When you
are pregnant, these substances can harm the unborn baby as well as the mother.
The substances enter the baby's bloodstream through the placenta. They can cause
birth defects and problems before, during, and after birth. A pregnant heroin
addict can addict her baby and cause the baby to have withdrawal symptoms after
birth.
If
you are pregnant and using, this will increase the chance of something going
wrong. It's better not to use at all whilst pregnant, but sometimes this can't
be helped. There are other things that affect the development of the foetus and
the general course of the pregnancy – like diet, stress, contact with
infectious diseases and physical health.
After
three months the foetus has fully formed and the rest of the pregnancy is mainly
growing time. If you’re using after three months, the most likely effect is
that the foetus will grow less quickly.
If
you are thinking of coming off opiates while you're pregnant, the best time is
between three and six months – after the foetus is fully formed so there’s
less likely to be a miscarriage, but not close enough to the end of the
pregnancy to go into premature labour. You need to go about it very gently,
because a rapid withdrawal has a greater effect on the uterus and foetus. Please
note however, that this is very dangerous. Do NOT attempt to detox
without speaking to a specialist midwife or your GP first, as it could result in
you miscarrying.
If
you do decide to stop using heroin and start on a Methadone program whilst you
are pregnant, you will still be able to breastfeed your baby. Trace elements of
everything that you eat, drink, smoke, inhale and/or inject are present in your
breast milk. But as Methadone is not harmful to your baby and because the
amounts in the breast milk are very small, it has been proved to be safe. It
is actually preferable to breastfeed, as this will help your baby get over any
withdrawal symptoms he may experience.
Babies
whose mothers have taken drugs during pregnancy may experience withdrawal. This
will depend on the drug, the dose, the purity, how often it is used and the
woman's general health. Drug withdrawal symptoms for the baby can occur both
during the pregnancy and after birth. There are common signs and symptoms of
drug withdrawal in the new-born baby regardless of which drug is used by the
mother.