Protecting the Unborn: The Problem of Expectant Mothers on Drugs

In recent years there has been a marked increase in the number of cases of drug abuse being discovered in pregnant women, and the question arises: Should government attempt to deal with this problem by protective actions to stop the drug use, through criminal sanctions to discourage the drug use, or in some other way? Can state and local government do anything at all about the problem?

Many drugs are known to damage the developing human inside the mother, and even more are under suspicion. Much remains to be learned about doses, timing and duration of use, but clearly all these factors, and more, influence the adverse effects. There is not enough firm scientific knowledge because animal experiments don’t predict human effects very well, and experiments with humans in such a dangerous area are out of the question.

Drugs harmful to the fetus include prescription drugs, over-the-counter drugs and illegal drugs. Alcohol, heroin and tobacco have well-documented effects. Drugs that affect the brain in any way can be harmful, and current medical practice recommends avoiding almost all of them. The more a particular drug is used, the more likely it is that harm will result; drug abuse is more dangerous than rare or occasional use.

Alcohol in large amounts early in pregnancy can produce a devastating syndrome including birth defects and severe mental impairment. Heroin late in pregnancy addicts the baby, and the withdrawal symptoms after birth can be extremely severe. Cocaine, PCP and amphetamines all appear to cause problems in newborn infants either from direct effects of the drugs or from withdrawal, and these drugs used early in pregnancy may well produce other forms of damage. Some of the problems are apparent at birth, but mild to moderate brain damage may not be apparent until a child is challenged by school and a disability is revealed.

Today, maternal drug abuse becomes known when a baby is born with a drug problem, when a known addict seeks care for pregnancy or, sometimes, when a pregnant woman has a urine test for drugs. Urine tests for pregnant women for other reasons have been routine for a long time; adding a drug screen to this routine urinalysis would not be expensive and would identify a fairly large set of pregnant women in need of help.

When the abuse of a drug continues after the baby is born (and it very often does), neglect or physical abuse of the baby is common. Mothers addicted to heroin and, in many cases, to other drugs cannot give adequate care to infants and their babies are almost always neglected or abused unless someone else provides the care. (Mothers in methadone programs are often able to provide care for their babies if they adhere to their programs and get some support.) Use of mind-altering drugs by fathers or other males in the household often reduces their tolerance for the normal stresses that babies impose, resulting sometimes in very severe or fatal abuse.

Persons who are abusing drugs rarely have much insight into the amount of harm they are doing to themselves or others. When they seek help, it is often because some event has occurred that forces them to do so.

It is hard to argue that a pregnant woman has some inherent “right” to abuse her baby along with herself. Intervention by the state in many cases of perinatal drug abuse appears to be appropriate on the grounds of protecting the unborn or the newborn from them.

In most drug cases, the mother intends to carry her baby to the time of birth and usually to keep and care for it later. In addition, getting pregnant women off drugs produces a real physical benefit to the mother as well as the baby even if the abstinence is externally imposed.

It would be easy, however, to develop a system of state intervention that would do considerably more harm than good. Limiting a pregnant woman’s access to drugs is likely to require limiting her freedom of movement. This may, in turn, require the “due process of law.” Experience with “protective due process” in child-abuse cases suggests that it can be very expensive and very ineffective, particularly when each case is litigated in an adversarial manner. The system readily determines which side has the better lawyer, but not what should be done to protect the child and family.

If legislation to protect babies from drugs were developed, it would almost surely result in the identification of many new cases, most of which would require litigation before involuntary drug rehabilitation could be imposed. This would lead to more court cases and more attorney’s fees--two ways to increase costs without gaining any benefits.

The use of criminal prosecution for those mothers who can be shown to have harmed their babies by the use of drugs in pregnancy would not be wrong, but it is surely an inefficient way to try to deal with the problem.

The problem is common and it is serious. Many infants are being harmed. Still, before a remedy is attempted that requires incarceration of pregnant women or mothers with drug-damaged babies, perhaps we should undertake a major campaign of public education to get the message to everyone about the risks of drug abuse in pregnancy. Coupled with this, we need to provide greatly enhanced facilities and programs for drug rehabilitation, especially for the young and the poor.

This approach would require leadership at all levels of government and in many parts of the private sector, but especially the media. It would cost a lot, but much less than the litigation of all the cases of drug abuse in pregnancy. The benefits of reducing drug abuse in this segment of the population would be considerable. Many individual mothers and babies might be helped, but so would our entire society.

The public-health effort over the last two decades to reduce tobacco use has been paying off magnificently, if rather quietly in the last few years, by extending the useful lives of thousands of us who used to smoke. It provides an example of what may be the best approach we have to the problems of drug abuse.

If we are serious about our announced intention to seek a drug-free society, there is no better place to begin than by dealing with the problem as it exists in the pregnant mother.