Professionals’ perspectives on alcohol or drug use during pregnancy

Vulnerability

Previous research has suggested, that 3-6 per cent of pregnant women in Denmark use alcohol or drugs during their pregnancy. However, it is likely that there exists a ‘hidden’ number in this area: an unknown number of women using AOD during pregnancy who are not enrolled in a specialized prenatal care program.

Women who use AOD during pregnancy are more vulnerable than those without AOD use. AOD use does not occur in a vacuum but in a complex life that makes these women vulnerable. Important factors are e.g. being younger, having tenuous relations to e.g. the father of the baby, having a psychiatric diagnosis, receiving cash benefits, and having unstable living conditions. The most vulnerable women are those who do not succeed to stop using AOD during early pregnancy.

Ambivalence and the ‘good mother’

Data from 56 patient records from specialized prenatal care and 18 interviews collected in 2019-2021 with practitioners from different services in Denmark, show that many women with AOD use are surprised when they find out that they are pregnant, and they are ambivalent about how to acknowledge it and whether and when to inform e.g. general practitioner about the situation. They often wish for a family life, and many view pregnancy as a window of opportunity, where they can change their life and reinvent themselves as mothers.

Although professionals advise women to attend substance use treatment, many do not want to, especially if it is a municipal treatment center for people with substance use of all kinds. This may be related to, female AOD users being more stigmatized than males, and pregnancy can add to this stigma, as AOD use in many cases is considered incompatible with the notion of the ‘good mother’. However, this view may be somewhat contradictory because the dream of becoming a good mother can be a powerful motivator for women to quit AOD use. If women experience relapse, professionals often intensify treatment, e.g. by having additional family network meetings.

AOD use or family life

If pregnant women struggle to end and not to relapse into AOD use, professionals often express heightened concern for the baby’s well-being. In some Danish municipalities, a concern scale is used, where 1 represents the highest level of concern, and 10 indicates no concern at all. Yet, these ratings tend to focus more on risks than resources, which can make the women feel uncomfortable. If concerns about the baby are high, professionals may consider it best to place the baby in foster care – though Danish research has shown that foster care does not always result in a positive change for the child in the long term.

However, in some cases where the professionals do not expect it, the woman may find focus and motivation, enabling her to end her AOD use and to build the family she did not have herself when growing up.

Different perspectives

Public debate in Denmark often centers on the possibility of involuntary treatment for pregnant women who use AOD. However, the discussions often overlook that many of these women long for a family, and that numerous women successfully end their AOD use in specialized prenatal care by focusing on their baby and family.  The fact that many women succeed in ending AOD use during pregnancy may be a motivator for more women to seek treatment. It is also essential not to overlook the most vulnerable women who, despite specialized prenatal care, struggle to end AOD use, as they may require more intensive support than outpatient care alone can provide.

These perspectives are all important to include in the debate.

The article is written by

Line Helland Boelskifte, Phd-candidate,

Centre for Alcohol and Drug research, Aarhus University

on the request of PopNAD