Disclosure of Substance Addiction during Pregnancy: A Complicated Decision

Background and Purpose:

Maternal addiction is predictive of negative child outcomes. Children whose mothers struggle with addiction during pregnancy are more likely to have poor perinatal outcomes, developmental delays, and mental health struggles later in childhood. Beyond the impact of prenatal exposure, maternal substance addiction is a contributing factor to child abuse and neglect. Pregnancy is the optimal time for women to access treatment services. Early access to services decreases prenatal exposure and enables women to begin parenting unimpeded by substance use. 

Understanding what motivates pregnant women to disclose substance use to health care professionals and begin the journey to recovery is a crucial first step in providing women with the resources they need. However, there is currently little research on the motivators that lead women to disclose addiction in pregnancy. Our research helps to fill this gap by examining the retrospective reports of women who’ve used drugs and alcohol during pregnancy and later accessed inpatient treatment services. 

Methods:

Semi-structured interviews were conducted with 15 women (Mean age 27.3) who accessed substance abuse treatment services either during pregnancy or immediately following the birth of their child. All participants were of low SES and reported receiving government assistance. 60% of participants identified methamphetamine as their main addiction and most reported illicit poly-substance use. Interviews elicited information about women’s decisions to disclose or not disclose their addiction to healthcare professionals as well as women’s overall pathways to accessing treatment. All interviews were transcribed and then iteratively coded to identify themes in women’s beliefs regarding disclosure of substance use.

Findings:

Data analysis reveals that women cautiously decide whether to disclose their addiction to a health care professional. Decisions are largely impacted by women’s concerns regarding child welfare involvement and loss of child custody due to their addiction. Women who did not disclose their addiction often described fear of child welfare involvement if they disclosed. Rather than seeking services, they often attempted to become clean on their own to prevent child welfare involvement. In contrast, women who disclosed their addiction to health care professionals saw accessing treatment as a means of “doing right by [my] baby.” They described being ready to overcome their addiction and wanting a lifestyle change. Women who disclosed their addiction generally had greater social support from family members and reported being better supported by health care and child welfare professionals.

Conclusions and Implications:

Findings identify the importance of women’s beliefs about child welfare involvement due to addiction in pregnancy. These beliefs can both act as a barrier to accessing care and a motivator to becoming clean. Pregnancy is a pivotal moment in women’s lives that provides a crucial opportunity for them to get help, not just for themselves, but also for their children. Our research suggests that treatments and interventions that allow women to access care and disclose their use without fear of consequence are necessary for women to have a healthy and drug-free pregnancy.