Lit Review

Thesis Statement

Topic of interest for the case of Suzanne is drug use during pregnancy. Thesis for this case is that pregnant women should stop taking drugs as soon as they learn they are pregnant and should continue to be drug free, at the very least until they deliver or stop breastfeeding.

Annotated Bibliography

Caughey, A. B. (2008). Tackling substance abuse in pregnancy: A cost-saving

approach. Journal of Perinatology, 28(9), 587-587. doi:10.1038/jp.2008.114

This article shows that early intervention can be the key to not only saving money but also saving little lives in the process. There was a new program that was started in order to combat preterm birth before the 33rd week of gestation. In this program all women are screened for drugs and only those that test positive continue on with treatment. This treatment is conducted by a substance abuse expert that is also licensed. What was found is that at least 100 substance abusing women need to be intervened in order to prevent one baby from being born before the 33rd week of gestation. It is a start.

Corse, S., & Smith, M. (1998). Reducing substance abuse during pregnancy. Journal of

Substance Abuse Treatment, 15(5), 457-467. doi:10.1016/S0740-5472(98)00027-0

This study focused on pregnant women that were substance abusers, including alcohol and other abusive substances. The women came into a medical facility for prenatal care and were offered substance abuse treatment as well in the form of available counselors. What was found is that at least half of the women reported refraining from continued substance abuse. There were differences in the number of women who stopped, reduced, or continued abusing substances and this was dependent on how many visits the woman made for prenatal care as well as how many actually used the available counseling sessions. It is a move in the right direction and shows great improvement with half of the women not using through the remainder of their pregnancy.

Heil, S. H., Jones, H. E., Arria, A., Kaltenbach, K., Coyle, M., Fischer, G.. . Martin, P. R.

(2011). Unintended pregnancy in opioid-abusing women. Journal of Substance Abuse Treatment, 40(2), 199-202. doi:10.1016/j.jsat.2010.08.011

This study looked at pregnancies among opioid users and defined them from bad timing, not wanted, or having mixed feelings on the matter. What was found is that there is a high rate of not wanted pregnancies among these types of abusers. The suggestion is that more interventions are needed to prevent the pregnancy to begin with. This means that more agencies need to advocate about safe sex or using contraception. By doing this the hope is that abusers will cut down on the number of unplanned pregnancies however it can be extremely difficult seeing as these are abusers and they are not in the clear mind to make the best choices.

Ingersoll, K. S., Ceperich, S. D., Hettema, J. E., Farrell-Carnahan, L., & Penberthy, J. K.

(2013). Preconceptional motivational interviewing interventions to reduce alcohol-exposed pregnancy risk. Journal of Substance Abuse Treatment, 44(4), 407-416. doi:10.1016/j.jsat.2012.10.001

This study looked at women that were drinking during pregnancy. This was an alternative study based off a previous, successful, study. The authors aimed to facilitate an interview in order to influence the woman to reduce or stop drinking. While this study was not ultimately successful it was an attempt that could be better facilitated later. It did show that while it was not completely successful there was enough change to want to continue in the study. The ultimate result is a suggestion to complete multiple interviews in order to truly get to the heart of the issue.

Lund, I. O., Brendryen, H., & Ravndal, E. (2014). A longitudinal study on substance use

and related problems in women in opioid maintenance treatment from pregnancy to four years after giving birth. Substance Abuse : Research and Treatment, 8, 35.

This study focused on what happens after a substance abusing woman is in treatment for their abuse and they have a child. The study continued with check-ins through 4 years after the birth of a child. What was found is that a mass majority, around 96 percent, remained as recovering addicts. There was an increase in the number of women that were diagnosed with mental health issues. It was also noted that the children of these mothers were in school and were voluntarily checking in with children services.

Pinto, S. M., Dodd, S., Walkinshaw, S. A., Siney, C., Kakkar, P., & Mousa, H. A. (2010).

Substance abuse during pregnancy: Effect on pregnancy outcomes. European Journal of Obstetrics and Gynecology, 150(2), 137-141. doi:10.1016/j.ejogrb.2010.02.026

This study looked at 247 women that were drug abusers and the study also had 741 controls that were looked at over a four year period. The purpose was to see if there were significant differences in pregnant women that abuse drugs compared to those women that do not abuse drugs. What was found is that there are differences among the women. These differences range in preterm labor, growth restriction, abruption, and low birth weight. These can be life threatening to the baby depending on how little or how early the baby is as well as if routine medical care has been maintained and a doctor is aware of the woman’s situation.

Sarkola, T., Gissler, M., Kahila, H., Autti-Rämö, I., & Halmesmäki, E. (2012). Alcohol

and substance abuse identified during pregnancy: Maternal morbidity, child morbidity and welfare interventions: Maternal abuse, child morbidity and foster care. Acta Paediatrica, 101(7), 784-790. doi:10.1111/j.1651-2227.2012.02670.x

This study looked at the after effects of women who are substance abusers that have children. Point of significance is that children born to these types of mothers have their own set of issues that range from preterm birth, low weight, as well as needing after hospital care. A lot of these mothers are not able to give the care that is needed. The study points also to women that are not only substance abusers but also to those that have mental health issues. Based on the child’s needs and the mother’s continued abuse children services are typically involved and this can become costly for the government as they seek homes to care for these needy children.

Vucinovic, M., Roje, D., Vucinovic, Z., Capkun, V., Bucat, M., & Banovic, I. (2008).

Maternal and neonatal effects of substance abuse during pregnancy: Our ten-year experience. Yonsei Medical Journal, 49(5), 705-713. doi:10.3349/ymj.2008.49.5.705

This study also focused on women that were giving birth but were addicted to drugs. The authors wanted to see if there were significant differences in types of delivery. This study was looked at over 10 years. Findings concluded that there were differences not only in preterm birth as well as low birth weight but also low apgar scores, how a baby responds when born and at specific time intervals after birth, as well as infant mortality rates. The differences are staggering when compared to women that are not drug abusers.

Case 1: Suzanne

Suzanne has come by the free “drop-in” counseling clinic were you work to get some information and advice. Suzanne is a 22-year-old single woman who has been living with her boyfriend Jack in Manhattan’s lower east side for the last four years. She and Jack have been heroin addicts for as many years. When Suzanne was 10 years old, her father, whom she says was a very heavy drinker, left her mom and the kids and never came back. At 14 she started drinking and smoking marijuana. At 16 she had dropped out of high school and at 18 she moved in with Jack. He introduced her to heroin. She reports using about a 1/2 gram of heroin per day just to be able to function and feel comfortable. In order to pay for the heroin and pay the rent on their apartment, Jack doesn’t work, instead, she works the streets at night. She usually drinks four or five beers each night before going out to work. If she can’t score enough heroin, she will try to score either some Valium™ or Klonopin™ to “tide me over until I can get some ‘horse’”. She says she has tried cocaine but, “I really didn’t care for the high all that much.”

Suzanne tells you that the alcohol and heroin help to calm her nerves and get her through the night. She and Jack are not having sex all that much. When they do make love he never wears a condom. He says that’s what makes him different from her johns, “Which is true because I won’t work without a condom.”Lately she has noticed that her breasts have become swollen and more tender. She also hasn’t had her period in the last 12 weeks. She is pretty sure she is pregnant and knows it’s her boyfriend’s baby. However she not sure she can stop using dope or work to have the baby even though Jack wants her to keep it. She really confused at what she should do and is her asking for you to help her make some decisions. Her friend who works with her at night told her not to stop using dope if she is pregnant “Because it’s worse for the baby than to keep using. I just don’t know what I should do?”