Treatment Options for Pregnant Women on Heroin

A model poses as a worried pregnant Mom-to-Be

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Pregnancy is a special time in a woman's life, and the discovery of a pregnancy is often when women reflect on many lifestyle choices — including substance use. Deciding on treatment options to address your heroin use is a wonderful gift for your baby as well as yourself, and can signify a fresh start in life for many women who are pregnant and on heroin.

Determining the best approach for treating your substance use should be done with your doctor, not on your own. There are many factors to consider, and your doctor is in the best position to advise you on the path that predicts the best start in life for your baby.

Will My Baby Be Taken Away If I Tell My Doctor?

Substance use during pregnancy can potentially be a reason for a child to be taken into child-welfare care, particularly if the mother's substance use is likely to negatively impact the health, safety, and emotional well-being of her child. Heroin use is a very serious type of drug use, which is associated with many risks for both mother and baby — before and after birth.

Seeking treatment as early as possible during pregnancy will increase your chances of being able to keep custody of your baby, and is more likely to lead to you receiving the care and support you need for a successful pregnancy and parenting your new baby.

Should I Quit Cold Turkey?

Although it might seem most sensible to stop taking drugs immediately, quitting cold turkey can be unsafe if you have been taking heroin for some time. Your risk of having a miscarriage increase if you go into heroin withdrawal, which is why methadone maintenance is often recommended for pregnant women taking heroin. However, you may be able to quit gradually with the help of your doctor.

What Is Considered in Choosing a Treatment Plan?

Whether or not quitting heroin gradually, using another prescription opiate, is a good idea will depend on many different factors related to your drug use, including:

  • Your history of substance use
  • How long you have been taking heroin
  • How much heroin you have been taking recently
  • How frequently you have been taking heroin and other drugs
  • Whether you have been taking any other drugs, and your feelings of dependency on those drugs
  • Your past attempts to quit or cut down on heroin, and other drugs, including alcohol

It will also depend on other health factors, including:

  • Whether you have other mental health problems that you self-medicate with heroin, such as post-traumatic stress disorder, anxiety disorder or depression, all of which are common in people who use heroin
  • Whether you suffer from chronic pain
  • Whether you have infectious diseases, such as TB, hepatitis, or HIV
  • Any other health concerns you have

Finally, the treatment plan you and your doctor decide on will depend on your current life circumstances, such as:

  • Whether you will have enough money for yourself and your baby to live on
  • Whether you have a supportive partner, family, or social network
  • Whether you have any lifestyle difficulties that are incompatible with raising a child, such as family violence or dependence on trading sex for money, food or shelter

Stability Is Key

Your doctor, and perhaps another helping professional such as a social worker or psychologist, can help you to figure out how you can be as stable as possible during and after your pregnancy. Although detox and therapy are often very helpful for people coming off heroin, keeping yourself stable and not using is safest for your baby, so sometimes these aspects of treatment are better delayed until after the baby has arrived. For this reason, methadone can often be the best way to get off heroin and give you the stability to put the rest of your life in order before the baby's birth.

The decision to go on methadone is not taken lightly, but remember, your doctor will be balancing the risks of the various options you have available. If you are on methadone, you are less likely to have a relapse to heroin use, and the associated risks of miscarriage or overdose.

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By Elizabeth Hartney, BSc, MSc, MA, PhD
Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada.