This article is part of a continuing series of articles examining illegal drugs in Fayette County.
From July 2012 through June 2013, Uniontown Hospital, the only hospital in Fayette County that provides obstetrical services, saw 1,037 babies born in the Family Beginnings Birthing Center.
About 30 percent — more than 300 of those babies — were born addicted to drugs, according to the center’s clinical director, Lea Walls.
“This is nearly double the national rate of 15.8 percent,” said Walls. She said she recently spoke with an obstetrician in Cumberland, Md., about an hour’s drive southeast of Fayette County, who said its rate is at 67 percent.
The mothers of those babies were addicted to street drugs or prescription pain medicine when they became pregnant, Walls said. From 2000 to 2009, she said there has been a fivefold increase in pregnant women using opiates.
Abuse of painkillers is the biggest problem, said Walls.
“These medications provide superior pain control for cancer and chronic pain but have been over-prescribed, diverted and sold illegally, creating a new opiate-addiction pathway and a public health burden for maternal and child health.”
According to licensed clinical social worker Liz Giachetti, who works with addicted mothers at CPP Behavioral Health in Uniontown, those women are not only surrounded by addiction but also past trauma or other underlying mental health issues feed into the abuse of drugs, making the task of beating the addiction exponentially challenging.
“Female substance abusers are also more likely to enter into dependent partner relationships,” said Giachetti. “What I see more commonly is that the partner is not the only addict. It goes way deeper than that to the mother, father, siblings, aunts, uncles and extended relatives. Almost every support has some type of substance abuse and mental illness.”
“As a whole, society needs to look at the expectations placed on women struggling with multiple issues and assess their level of burden before we judge them,” Giachetti said.
There are no states that consider prenatal substance abuse a criminal act of child abuse and neglect, and only a few states require health-care providers to test for and report prenatal drug exposure, according to the American Pregnancy Association.
Giachetti said confidentiality laws are in place between patients and treatment providers to protect the mothers, so they can feel secure about their treatment and be open with counselors without fear of punishment.
And she said she finds that women do want to do what’s best for their babies, even while caught in the throes of addiction.
“Pregnant women, even those abusing drugs, do not want anything to happen to their unborn children, and this makes pregnancy an opportunity to initiate change,” said Giachetti.
Continued, unmanaged drug use can have fatal consequences for developing fetuses, according to the American Congress of Obstetricians and Gynecologists (ACOG).
During pregnancy, chronic, untreated opioid use is associated with an increased risk of fetal growth restriction, placental abruption, fetal death, preterm labor and intrauterine passage of fetal waste material, the ACOG states.
Additionally, the ACOG advises that the lifestyle issues associated with illicit drug use put the pregnant woman at risk of engaging in activities such as prostitution, theft and violence to support herself or her addiction. Such activities expose women to sexually transmitted infections, physical abuse and legal consequences, including loss of child custody, criminal proceedings or incarceration.
Becoming pregnant can be a life event that propels a woman to seek treatment for her addiction, said Giachetti.
Research shows that pregnant women are four times more likely than non-pregnant women to express greater motivation for treatment of drug addiction, she said.
“Yet stigma and fear keep pregnant women from seeking help. The biggest challenge to getting women help and protecting infants from prenatal drug exposure is fighting the stigma associated with drug use.”
Many of those women are already facing other difficulties, said Giachetti. About two-thirds of women with substance abuse problems also have mental health issues such as depression, anxiety or post-traumatic stress disorder, she said.
“Past physical and sexual abuse complicates the treatment of substance abuse as females use the illicit substances to self-medicate in an effort to cope with these traumatic events,” said Giachetti.
There are a variety of treatment options available, ranging from nine hours a week of outpatient counseling to medically monitored intensive inpatient care with around-the-clock observation.
“The treatment of addiction has changed, and the needs of pregnant women have opened clinicians’ eyes to look at better, more holistic treatment for pregnant women that acknowledges their psychological needs,” said Giachetti. “Individualized treatment planning is essential in promoting positive outcomes.”
For some women, supervised medication-assisted treatment, including the use of methadone and buprenorphine in an outpatient setting, can be highly effective, Giachetti said.
According to the ACOG, “The rationale for opioid-assisted therapy during pregnancy is to prevent complications of illicit opioid use and narcotic withdrawal, encourage prenatal care and drug treatment, reduce criminal activity and avoid risks to the patient of associating with a drug culture.” The organization also recommends against medically supervised withdrawal from opioids because the withdrawal is associated with high relapse rates.
No matter what treatment course a woman opts to take, Giachetti noted that, “Women who seek treatment and invest in their own personal stages of recovery and self-acceptance will develop the strength and resilience to beat their addiction.”
“The key is to develop effective services for women and to acknowledge and understand their life experiences, as well as the impact their stories have had on their lives.”