Whether you're using heroin, fentanyl, or prescription opioids like Oxycodone or Dilaudid, pregnancy changes everything. With being pregnant, you now have to consider both your well being and that of your baby. Being pregnant and dealing with a substance use disorder, whether to heroin or other opioids, is challenging but not an impossible feat if you get the right information and supports in place.
You may be worried that letting anyone know you're pregnant and addicted will mean you could be prosecuted, be civilly committed for the length of the pregnancy, and/or have to give up your baby before you even have a chance to be a mother. Just stopping opioids cold turkey isn't the answer either as stopping suddenly without safely tapering under medical supervision can put you and your baby at risk as well.
Opioid use in pregnancy can increase your risk of miscarriage, preterm labor and preterm birth, having a baby with certain birth defects, including spina bifida and cardiac defects; low birthweight and poor fetal growth for the baby, and neonatal abstinence syndrome (NAS). NAS occurs when a baby is born addicted to drugs due to exposure in the womb. After birth, the baby goes through withdrawal symptoms.
Stopping opioids suddenly is dangerous as well. Preterm labor and birth, fetal growth issues, and stillbirth are all risks. Placental abruption can occur as a result of stopping opioids which is a risk to the mother and the baby. In placental abruption, the placenta separates from the uterine wall and may cause life threatening bleeding for both the baby and mother.
Physicians advocate a public health response to help women who are addicted to opioids and pregnant. If you are addicted to drugs, be consistent with birth control and avoid pregnancy. If you are pregnant and addicted, seek out information and support from a health care provider to guide your health care.
Some states do have stricter policies of prosecution and reporting of addiction than others. This map of the United States gives an overview of the laws and reporting policies of different states regarding women who are addicted while pregnant. (https://projects.propublica.org/graphics/maternity-drug-policies-by-state ) Tennessee is the only state to have a specific law making it a crime to use drugs when pregnant. Some states do require health care providers to report suspected drug use of their pregnant patients to authorities. You can search online for your state's laws and regulations or contact a local chapter of an organization like March of Dimes or other women's organization that can advise you anonymously if you are concerned to approach your health care provider directly.
There are clinics and medical practices that specialize in working with women who are addicted to drugs and pregnant. For opioid addiction, physicians often recommend MAT(medication assisted treatment) or OAT (opioid assisted treatment). With either MAT or OAT, you're prescribed a long acting opioid, such as buprenorphine or methadone, for the length of your pregnancy and for a short time after birth. Your use would be monitored by the physician during the preganancy. Using MAT and OAT doesn't guarantee your baby won't be born with NAS, but you will be showing you are taking responsibility by working closely with your health care provider to ensure the health and well being of you and your baby. If you are planning on breastfeeding your baby, discuss your plans with your health care provider.Breastfeeding is an option even on MAT or OAT if you are healthy, take the medications as prescribed, and avoid street drugs. Once your doctor clears you to come off MAT or OAT post-pregnancy, you'll be able to move forward into an addiction-free life with your new baby.
While MAT or OAT can be a short term strategy for pregnancy, for the long term ending your dependence on opioids can free you to live your life without restrictions. You can safely detox from opioid use with the help of your health care provider . If you would like to learn more about how to enjoy your new life with your bundle of joy free from addiction, The Freedom Model from Addictions can help you make different choices moving forward and leave opioid use in your past.