This section was informed by a literature scan and consultation with people who work and advocate within the maternity sector in 2023.
When someone is pregnant, stigma associated with substance use is amplified because of the impacts that substances can have on a baby (such as foetal alcohol spectrum disorder from alcohol use during pregnancy), and stereotypes and expectations of new parents. Fear of being treated differently or risking losing custody of their children can mean parents may not access healthcare or may not disclose substance use if they do.
Harm reduction strategies provided for pregnant people have been shown to improve health outcomes for both parents and children as they are more likely to compel people to disclose their substance use and to access maternity care.
Access to health and social services during and after pregnancy, and to harm reduction interventions, has been found to improve health outcomes for parents and children. Services delivered according to harm reduction principles have also been shown to increase breastfeeding rates and facilitate early attachment and healthy childhood development.
When interacting with pregnant people and parents with newborns, incorporating harm reduction practices centred in collaboration, respect, acceptance, empowerment, and compassion can help to prevent and reduce harms for parents who use drugs, and their children.
“Being non-judgemental and supportive is key in terms of professionals in the peri-natal period and having good supports available to offer people. We find that professionals don’t always ask about substance use as they don’t know what to say if someone does say they are using and wants help.”
– Addictions practitioner working in maternal care
Sexual Wellbeing Aotearoa estimates that about 40% of pregnancies in New Zealand are unintended. Alcohol and some other drugs are used regularly by New Zealand adults. Therefore, many people may be using alcohol or other drugs before a pregnancy is confirmed.
Further work is needed to develop guidance for health professionals working with parents who use substances. This could include developing specific guidance and harm reduction information for this population – helping to reduce preventable health problems. In addition, specific harm reduction initiatives that provide antenatal, postnatal, and early childhood care for parents who use substances could help to reduce stigma and enhance healthcare access.
Key considerations:
- Talk about sex and the possibility of pregnancy with people who use drugs. Confirming whether someone is pregnant or not as early as possible gives people time to make choices that are best for them, and provides opportunities to connect them to care.
- If someone is pregnant, and decides to continue the pregnancy, getting non-judgemental and evidence-informed antenatal care is crucial and can prevent complications or problems.
- Pregnant people often do not disclose alcohol and other drug use because of stigma or fear that they may lose custody of their children. Respectful and clear communication by professionals may remove barriers and encourage people to be honest about their substance use. This can lead to better outcomes for the parent (or caregiver) and baby. To help open and honest conversations continue, avoid shaming or judging parents when you let them know that stopping all substance use during pregnancy is recommended.
- Outline all options without judgement. A pregnant person may want to explore stopping, changing, or reducing their substance use, or termination of the pregnancy. Sometimes, substance use can become the focus point of discussion; however, it is important for pregnant people to know that there are many steps that can be taken to have a healthy pregnancy.
- Consider the option of opioid substitution treatment for pregnant people who use opioids. Having a stable dose can lead to a more settled lifestyle, improved nutrition, less stress, and reduce the chances of unexpected periods of withdrawal that can be harmful to the baby. Medication supplied by a pharmacy or treatment centre also ensures the substance is what it is labelled as.
- Explore the support network for the pregnant person, and whether these people know about their substance use or not. A strong support network can help the parents develop plans to reduce risk and ensure they have the information and support that they need.
- Substance use during pregnancy, including cigarette smoking, can increase the chances of the baby being born early and make them more vulnerable to sudden unexplained death in infancy (SUDI). Talk with parents about all the healthcare support that they can have for their babies and about safe sleep spaces.
- Talk with parents about how they are coping and their mental health. This includes after the baby is born.
- Outline how specific substances can affect lactation and breast/chestfeeding. Knowing how specific substances may be passed to the baby through breast milk is important. Information can be accessed by health professionals and through trusted websites such as the US National Institute of Health’s Drug and Lactation Database (LactMed®) and on the Plunket Whānau Āwhina website.
- Help parents plan for the care and safety of their child when they use alcohol or other drugs. This might include asking a trusted person to look after the child/children, storing substances safely, or using less to reduce recovery time.
The Pregnancy and Substance Use: A harm reduction toolkit resource from the National Harm Reduction Coalition and the Academy of Perinatal Harm Reduction contains useful information.