Discussions of Infant Exposure and Withdrawal Symptoms with Substance Using Moms

Background and Purpose: Prenatal drug exposure can cause complex challenges for substance- exposed infants. Successfully managing maternal substance use during pregnancy can improve maternal mental health and neonate outcomes (Silber-Ashley, 2003). Despite improved physical outcomes for neonates, prenatal exposure to methadone and suboxone can still result in a neonate experiencing significant withdrawal symptoms, which, in turn, can trigger child welfare involvement as well as caregiver distress. There is limited research on how parents with a substance use disorder (SUD) understands the impact of treating addiction during pregnancy, and accordingly, make choices about which treatment, if any, to pursue. This research fills an important gap in knowledge in this area with the potential to improve practice.

Methods: Data from this study is drawn from a larger project examining treatment for caregivers with SUD at risk for involvement in the child welfare system in a Northeastern state. Twenty-nine in-depth, semi-structured Working Model of the Child Interviews (WMCI) were conducted with mothers receiving treatment for SUD. The WMCI (Zeanah, Benoit, & Barton, 1986) assesses caregiver internal representations of their child and the relationship with the child. Three of the interviews were excluded due to being more than 50% incomplete. The remaining 26 interviews were qualitatively analyzed, using content analysis, to examine maternal concerns related to the index child’s in utero substance exposure and/or descriptions of neonatal withdrawal.

Findings: Data analysis reveals that 57% of mothers in treatment for SUD reported concerns related to their child’s prenatal substance exposure when asked a general question about their pregnancy and childbirth experiences. Among those who shared concerns related to the in-utero substance exposure, 33% reported the use of illegal drugs and/or alcohol while pregnant and another 60% reported that their baby’s substance exposure was due to detox medication. In this sample, 66% of these mothers reported that their infants had neonatal withdrawal symptoms that necessitated extended neonate intensive care (NICU) treatment. Concerningly, 13% of these mothers reported that they did not expect their baby to go into withdrawal and/or would have changed their detox medication if they had anticipated the severity of their newborns’ withdrawal symptoms.

Conclusion and Implications: Findings suggest that mothers in treatment for SUD are clearly concerned about their infant’s well-being. They express significant guilt regarding in utero drug exposure, as well as concerns about neonatal withdrawal symptoms. Further, a minority of these mothers did not expect their medication would induce withdrawal symptoms. These findings suggest that pregnant mothers with SUD may benefit from clearer counselling surrounding detox medication treatment options and its impact on the fetus. Given the significant numbers of women who reported that their newborns experienced severe withdrawal symptoms that necessitated several weeklong stays in the NICU, more research, treatment options, and clearer anticipatory guidance are vital for women to make informed decisions. Preparing women for withdrawal symptoms and a NICU stay has the potential to ease the psychosocial stresses associated with these experiences and promote attachment.