Better Than Punishment

From an editorial by Dr Ruchi Fitzgerald in LINK>The Hill – It is unimaginable to think that seeking medical care could lead to losing custody of their children, yet this devastating predicament is all too real for pregnant women with addiction in the United States.

In our nation, the systems that aim to protect children from the negative effects of parental substance use often prioritize punitive approaches over proven public health strategies. Fear of being imprisoned, stigmatized, or having their children removed makes many pregnant women with substance use disorder (SUD) afraid to seek medical care, contributing to poor maternal health outcomes. Some state laws, including the law in Illinois where I practice medicine, even mandate that health care professionals report cases of detected controlled substances in a newborn infant as evidence of child neglect. While the federal Child Abuse Prevention and Treatment Act (CAPTA) has no such requirement, CAPTA’s overall approach has led to significant variation in how states, counties, and health care institutions implement its reporting requirements when substance use is involved during pregnancy.

Threatening child removal from a birthing parent with SUD without a risk assessment or evidence of danger to the child is not ultimately improving outcomes for children. Research has long shown that children affected by the trauma of family separation tend to experience worse long-term outcomes on a wide variety of indicators, including education, health, housing, employment, substance use, and involvement with the criminal legal system. With over 400,000 children in foster care across the US, the trauma of separation is widespread.

Forced separation also brings unimaginable pain to new families – triggering in some parents such despair that it deters them from seeking or continuing medical care, including treatment for their SUD. Study after study shows child removal is associated with parental overdose, mental illness, post-traumatic stress disorder, and return to substance use. Public health-oriented policies that can result in better outcomes for families are part of the solution.

As an addiction specialist physician, I am involved with the medical care of pregnant people with SUD, and I have seen counterproductive child welfare and criminal investigations launched after a newborn infant tests positive for a controlled substance. Too often, parents become hopeless about recovery once their children are gone.

Current policies and practices related to substance use during pregnancy also result in serious health inequities. Pregnant and parenting people of color are much more likely to be impacted by forced separation than their white counterparts. Black parents are more likely than white parents to be reported for substance use to the child protection system at their child’s delivery despite similar rates of drug use, while Black and Native American children are overrepresented in foster care relative to white children in the setting of parental substance use.

Meanwhile, health outcomes are unnecessarily worse for mothers of color. Since 80% of maternal deaths are due to overdose or suicide, we can save lives with policies and practices that encourage treatment, not punish pregnant women with SUD for seeking it. Policymakers need to remove controlled substance reporting requirements that overreach and contribute to the current punitive approach.

The American Society of Addiction Medicine (ASAM) encourages child protective services agencies not to use evidence of substance use, alone, to sanction parents—especially with child removal; supports eliminating in-utero substance exposure language in child abuse and neglect statutes, and supports policies that extend social services benefits and financial support to families in need.

The US Senate will contemplate reauthorizing and reforming CAPTA this year. Health care professionals who treat pregnant people with medications for addiction, like methadone or buprenorphine for opioid use disorder, do not need to involve child protective services for that reason.

Recovery is possible with the right medical care and support. A pregnant person with addiction seeking medical care deserves a chance to heal and recover with her children. If we want pregnant and parenting people with addiction to access the evidence-based treatment they need, our decision-makers must embrace public health over punitive policies.

Only Way Passed Is Through

For adoptees and mothers of loss in reunion, the Thanksgiving holiday and getting everyone together can cause some anxious moments. One must simply say yes to the opportunity that was not a possibility for so long. We never know how such experiences are going to turn out but an inspirational message I listen to each week, said that saying Yes is the seed that creates the experience.

One adoptee writes – I invited my (birth, first) mom to Thanksgiving with my mother-and-siblings-in-law. My nephew is coming too, my sister already had prior plans. I just started reading The Primal Wound and I’m worried I’m gonna be just an emotional wreck. But my birth mom has been doing a lot of work around her trauma with it all. She placed 2 kids for adoption but another one overdosed last year.

Another adoptee writes – I’m going to my natural uncle’s house next week for Thanksgiving, and my natural mother and brother will be there too. It’s always emotional and I think it always will be. Honestly, I don’t even know why I go because it’s awkward for me. But the awkwardness is familiar at this point. I want my daughter to know her family, even if I have a hard time thinking of them as family.

Another adoptee had this advice – If your body is saying no or to hold off, then there’s a reason for that. Forcing it may cause you to experience more further trauma than you need right now. Once a trauma wound is created, there’s no going back and undoing it. So again, go with what your body is telling you. If your body is saying it may not be the best timing right now, that doesn’t mean you can’t pursue it further in the future. It’s your life and your choice. The only one you answer to is you, not them. Do what is best for you, and however it plays out will be what it is. But don’t let anyone bully or manipulate you into feeling obligated. You aren’t. The only person you owe an explanation to is yourself, even if you feel otherwise. At the end of the day you need to fight for your own healing and safe boundaries. If this gathering doesn’t fit in those spaces this year, then honor yourself by not going. If it feels right and like you are prepared, then go and remember to honor yourself. None of these decisions are easy. It’s all a tangled mess. Whether it’s them or not going, I hope you ultimately choose yourself first, because you are worth it.

From a first mother in reunion – been with our son, his parents and other family many times, including holidays and intense gatherings. Best advice: your feelings are the most important of anyone else in the room. You may have a tendency to want to protect or care take others. Not your job!! Try not to worry about them. Focus on having a good time. Keep it light. It’s pretty amazing you are all together. You will have time to process later. Big emotions do come and go. On Thanksgiving, enjoy the day. You are very courageous – stand in this knowing.

From another first mom – in reunion with my daughter for 7 years. She’s coming to stay tonight with her 3 kids. When we first met, we both discussed how nervous we were but it all unfolded very naturally. I’m in phone contact with my son and he wants to meet up before Xmas and I feel just as nervous again, Although you never know how things will play out, you have to start somewhere. Being nervous is very normal.

When A Mother Doesn’t Want Her Child

Today’s adoptee story (not my own story) – Being adopted is having all of your rights stripped from you the minute you take a breath and become declared a human. That was my case. I had what is called a closed adoption.

There are many reasons people put their child up for adoption. Some women are coerced. Some have their children stolen. Some women just don’t want their child. That was me.

My birth mother named me, wrote down all of the non-identifying information about herself, her parents, my birth father, and his parents, and walked away to a fresh new start.

She had the child. She didn’t abort it. Many would agree that makes her a born again saint.

This is where no one wants to admit that the child will probably have many problems. That child was just given your epigenetics. The feelings you had while pregnant are now part of who that child is.

As for my mother, we have to assume things because she never used her words because she would never meet me or speak to me. She made me a living abortion by never having any responsibility or accountability for her actions. I assume she felt shame, guilt, embarrassment, anger, anxiety, and depression.

When my sisters and cousins met me, everyone said how much I looked like my mother and acted like her.

My emotions were torn.

I had always wanted to look and act like my family. Now I do, and the woman that gave birth to me is also the cause of my trauma. I wanted to rip my DNA out of my body.

I had suffered from anxiety, depression, and suicidal ideation for most of my life. I had been given Prozac and Zoloft when I was in my mid 20’s. They caused me extreme pain in the back of my head. I came off of them and took an overdose of muscle relaxers one night and ended up in a psych ward over the weekend.

When I met with the doctor, he told me the prescriptions would have killed me had I not stopped taking them. I was having a reaction because of my low blood pressure. I did see a psychologist a few times after that, but it wasn’t any help.

I spent many years thinking I was fine after that. I had also learned not to let anyone really know what I was thinking after that.

I was in what is known as the “fog.” I went on with my life. I worked a lot and drank. I thought if I just stayed ahead of what I felt, I was ok.

The pain from adoption is there, whether we admit it or not. You can see it in people’s eyes when you say you’re adopted. They get that I’m sorry look. With so many people aware of the trauma adoption causes, you would think it would change.

As for me, I am doing everything I can now, to fix my epigenetics from my mother.

Opioid Orphans

It is so sad that medications meant to relieve serious pain have become such a travesty that people who might benefit from them find it hard to receive a prescription. I understand the complication. I have been prescribed such medications and though I never became addicted, I could see the temptation and how the drug fixes itself upon the person.

I have experienced the awareness that my ex-husband overdosed and gratefully survived the experience. When he came home he told me his friend dumped him out at the emergency room. Not long after, that friend actually died of an overdose himself. His family lived next door to my in-laws and they quite obviously, and reasonably, distanced themselves from my ex at the time – though he was not at all responsible for his friend’s death. Parents have a hard time accepting such a hard truth at the time they lose their child.

Today, many grandparents will be forced to rescue their grandchildren after such an event. Fortunately, the death I described above was a person without children. Though perhaps a few years away from retirement, they find themselves full-time parents again. This is the collateral damage caused by the opioid crisis.

As the opioid epidemic has spread across the country, through all age, gender, race and economic categories, the number of children who have lost their parents to drugs—either to death by overdose, to jail, prison, homelessness or disability—has skyrocketed. Those children wind up in one of two places: either with relatives, or in an already overburdened foster care system. In 2015, the child welfare system saw a three-year national increase of more than 30,000 children entering foster care. That number is likely much higher now as the nation finally begins to face the truth and pharmaceutical companies are being held to account.

In West Virginia, the hardest hit state in the opioid crisis, the number of foster care children grew 24 percent from 2012-2016. The numbers escalate as the number of overdoses increase; they mirror the number of addicts in treatment programs, incarceration or living day-to-day on the streets. Babies are born addicted to opioids or other drugs. More often than not, addict parents, living or deceased, have made little or no provisions for the ongoing care of their children.