How you can save babies whose mothers have substance use disorders

The statistics are shocking: ten percent or more of babies born in the United States test positive for alcohol or another mind-altering substance used by the mother struggling with substance use disorder. Babies born prenatally exposed to alcohol can suffer from a host of significant impairments. Babies born addicted to opiates have to start life going through the same agonizing withdrawal process as adults. Other mind-altering substances have a long list of harmful, potentially life-long impacts on children.

Should we punish “bad” mothers with substance use disorders?

In a society where mothers are judged harshly for every imaginable decision, it’s easy to unite in condemnation of “these horrible mothers” who use drugs during pregnancy.

The only question is, what punishment is severe enough? Immediate removal of the baby? Arresting the mother? These options make us feel a little better. 

Suppose the goal is to placate parents who are angry that they have sacrificed so much without reward while other mothers seem to misbehave without consequence. In that case, we should probably invest in stocks, gallows, and town squares with excellent visibility. But if we are going to get indignant and angry on behalf of babies, we should probably view this problem from their point of view.

The inception of ACEs and attachment disorders

Babies are born loving their mothers and anyone else whose voice was familiar to them in utero. They are blissfully ignorant of the circumstances of their conception, their mother’s socioeconomic status, and many other adult hang-ups.

Removing babies from their mother, their primary attachment figure, is inherently harmful to them. Preventing a baby from bonding with their mother after birth increases the risk of the child experiencing attachment disorders. It is also experienced as abandonment by the baby, the same way that a parent’s death or arrest is. A single ACE and a single instance of disrupted attachment are undesirable but usually surmountable, but limiting the baby to a single incident can be difficult. 

What happens to babies when taken away from their mothers?

Foster care and attachment disorders

When we remove a baby from their mother, they are most likely going into some version of foster care. In traditional foster care, a trained stranger raises the baby with some monitoring from the local Child Protective Services and financial supports such as SNAP (food stamps), Medicaid, and a cash per diem.

Unfortunately, we don’t consistently train enough foster parents to care for a baby suffering from prenatal substance exposure, which may contribute to their refusing to further care for the baby. The baby moves to another home, another attachment trauma. The more placements a baby experiences, the more likely attachment disorders are.

Bonding is also a two-way street; a foster parent isn’t likely to bond with a baby with the same intensity as the baby’s mother. And foster care, as a whole, has atrocious outcomes. 

Relatives and the cycle of trauma

It is also possible the baby will be placed with a relative in what is sometimes known as “shadow foster care.”

The potential advantage is that the baby remains within the extended family. Possible disadvantages are that this system is often less regulated, caregivers often get less training, less monitoring, little to no background checking, and fewer financial supports.

In many states, grandparents need to be notified if a child is placed in foster care, and they need to be given preference as caregivers. Sometimes this works well. Other times babies are placed in the same familial situation that caused a child to grow up so traumatized they used drugs while pregnant. Mothers with substance use disorders are an unfortunate result of ACEs.

The monitoring, training, and financial support that traditional foster parents get could be helpful in some of these situations but are rarely offered, setting the stage for trauma and ACEs to cycle through another generation. 

“Bad” mothers and their babies need help, not judgment

Removing a baby is always harmful to the baby. Growing up with a parent with unmanaged substance abuse disorder is an ACE, so it’s inherently undesirable. And living with a parent with unmanaged substance abuse disorder can also have other safety concerns.

A mother who is homeless and engages in constant illegal activity to purchase a daily supply of drugs is unlikely to provide her baby with the safety and care an infant needs. A mother who has support, stable housing and income, and is committed to sobriety is likely to thrive as a mother. 

It’s easy to label the mother in the first vignette as a “bad” mother and the one in the second as a “good” mother. This is an unhelpful worldview. It is possible that the mothers in each vignette started bonding with their babies during pregnancy and will use every bit of their strength and will to make themselves into better mothers. If they lose custody, both will be devastated and likely deal with that devastation through more substance abuse, decreasing the odds of an excellent long-term outcome for them or the baby. 

Maternal Home Visiting programs help mothers with substance use disorders

The ideal solution involves keeping the baby with their mother but ensuring the mother has housing, income, stability, and support as she tries to navigate sobriety.

Fortunately, some programs are designed to help. Women participating in a maternal home visiting (MHV) program are more likely to achieve long-term sobriety than women who don’t. A recent study also suggests that maternal home visitation programs focused on helping addicted mothers bond and parents better reduced some risk factors for abuse and neglect, even before they achieve sobriety.  

The purpose of MHV programs

A home visitor’s priority is always the baby, but they believe the baby is best helped by helping the mother.

Advantages of a home visit and objectives of Maternal Home Visiting

• The visitor helps the mother understand their options for treatment and helps remove the barriers to those treatments, which can involve masses of bureaucracy. Some services like Medical Assisted Therapy can be tough to access).
• They help ensure the mother can access health care for herself and help ensure the baby is seeing their pediatrician regularly.
• In many MIECHV programs, the visitor performs developmental screenings with the babies; babies exposed to drugs prenatally are at elevated risk for various developmental delays. Early intervention can reduce their effects, so screening is beneficial.
• Home visitors teach about parenting. And they support the mother through a complicated part of her life.
• They also keep an eye on the baby; if the baby’s situation is unsafe or if the visitor witnesses abuse, they need to call CPS by law. 

Investing in MHV programs means a healthier future

As satisfying as it is to hate mothers who expose their babies to drugs in utero, the only thing that has been shown to help the babies also helps these same mothers. 

If we can let evidence supplant hatred and invest in the Maternal Home Visiting programs that work, we can start to envision a future full of healthier families and fewer ACEs. Start here.