Addiction and recovery during pregnancy

December 30, 2022

Swedish Women's Health Team

[7 MIN READ]

Courage, strength, determination and compassion radiate through the screen at the weekly zoom-based medically shared group for moms in recovery from substance use disorder (SUD).
The birthing parent group is facilitated by Vania Rudolf, M.D., MPH, one of several addiction and recovery specialists who works along Mollie Nisen, MD, Deedee Paster, MD, Jackie Wong, MD, Catherine Smith, MD, Collin Schenk, MD, Greg Parada, MD and Jim Walsh, MD.

SUD is a stigmatized medical condition that impacts 10% of the adult population. It is poorly understood for pregnant and postpartum people, who face discrimination accessing care and treatment. Pregnant people often experience challenges that limit their access to needed support and treatment. This can lead to increased maternal mortality and opioid-involved pregnancies in as many as 6 percent of childbirths.

Swedish Medical Center and Addiction Recovery Services are deeply committed to the health and well-being of pregnant and postpartum people, their families and communities. This includes advocating for the prevention and treatment of substance use-related harms throughout the reproductive years, with a focus on the perinatal period.

Addiction services include whole person and harm reduction approaches that are comprehensive and longitudinal throughout the life cycle. One example is a medically shared Zoom framework that offers online support for women with opioid use disorder (OUD). In this article they share their stories and reflect on the unique challenges of addiction and recovery care during pregnancy.

“We live in unprecedented times – we face COVID, opioid use, stigma, racism and pandemics all at once,” says Dr. Rudolf. “At Swedish, we embrace harm reduction and trauma-informed perspective. We offer care to meet people where they are,” she shares.

“To address systemic issues of inequality, we’ve created a compassionate, inclusive and welcoming environment in an online group setting,” explains Dr. Rudolf. “We were looking to focus on expanding access for pregnant and parenting individuals with SUD, particularly people who have been marginalized, traditionally overlooked and who have received subpar care within the traditional prenatal care system.”

“We focus on holistic, harm-reduction and trauma-responsive approach. We discuss parenting and motherhood, with a strong emphasis on recovery, self-efficacy, resilience and wellness. Group sessions are a safe space for individuals to share their thoughts, concerns and life expectations in a safe space where they feel respected,” she continues.

Dr. Rudolf shares how the group Zoom model supports a flexible, provider-facilitated telehealth framework that fosters respectful, compassionate care while addressing health disparities often amplified due to the intersectionality of various identities (culture/race, class, gender, physical ability, active SUD and mental illness), stigma and lack of access to care.

“The Zoom structure offers a welcoming environment in a manner that is equitable for individuals of all backgrounds. Patient-centered care, with providers attuned to bias and its impact on healthcare and disparities, helps provide social support and address stigma that many minorities, LGBTQIA, non-heteronormative, non-traditional families and/or low socioeconomic status individuals face. We empower patients to strengthen their journey through improved access, diversity, equity, equality and focus on recovery,” says Dr. Rudolf.

The medically shared group model was presented at the National Addiction Conference 2022, and is now being embraced by March of Dimes, Providence, other health systems and health professional groups.

During the one-hour sessions, each woman gives voice to her story – sharing struggles and triumphs or offering words of support to others. Their journeys are unique, and all share a common thread of persistence and hope. Some participants generously shared their stories with us. In order to protect their privacy, we have changed their names and some personal details.

Substance use during pregnancy

Addiction and overdose rates reached historic highs in the last several years. And while fentanyl and synthetic opioids are responsible for much of the surge, cocaine and other stimulants such as methamphetamine are playing an increasingly common role, according to a recent statement from the Office of National Drug Control Policy.

“Addiction problems are not rare,” says James Walsh, M.D., who specializes in addiction and recovery care at Swedish. About 10% of humans in general have substance use problems. That doesn’t go away just because you’re pregnant.”

Pregnant people with SUD often experience feelings of shame and guilt that prevent them from seeking the help they need. But if left unaddressed, substance use disorder can cause many adverse health outcomes for both baby and mom during pregnancy and after delivery.

According to the Centers for Disease Control and Prevention, substance use during pregnancy may cause:

Preterm birth
Stillbirth
Maternal death
Neonatal abstinence syndrome

Using evidence-based recovery care and pairing it with additional resources and support, pregnant people can often experience positive results.

“Pregnant people probably try harder than anybody else to quit because they’re so motivated,” says Dr. Walsh. “But pregnancy is a complicated time with many physical and emotional stressors that don’t make it easy to make a big change. People who are pregnant and who have a substance disorder deserve and need the help to move forward.”

Growth through hardship

“Sharing their stories allows the group to reflect on their hardships and recognize how strong they’ve grown,” says Dr. Rudolf. “Each recovery journey has hard and challenging moments. It takes a lot of courage to have willingness and to reach out for help. Difficult times are an opportunity to be brave and to affirm your strengths and hone your resilience. Our mission is to offer a whole-person approach through respect, support, education, encouragement and empowerment. We believe a positive compassionate regard and “person-first” language are essential for respecting people’s choices, individual beliefs, autonomy and gender identity,” she explains.

Linda

“I’ve learned that the things I go through are just things. And things change,” says Linda. “Just because you’re going through something difficult right now doesn’t mean it’ll last forever. You’ll gain knowledge and get stronger and you’ll move forward. And that’s what life’s about, learning and moving forward.”

“It’s about learning from the things we go through and developing a callous so that things don’t hurt you as much when you go through them the next time. And you continue to grow. And as you grow, you propel forward. And life gets easier and your recovery pathway gets stronger,” she adds.

“When I joined this group, I wasn’t used to sharing, talking or being in groups at all. And at first, I was really quiet. But everybody’s just so welcoming. Everybody’s so resilient. Everybody finds a way to help encourage each other and welcome each other. It’s a safe space to share, to be yourself and broker the pain of your recovery,” she continues.

“On days of weakness, everybody’s there to give you strength and to encourage you to push on. There’s somebody to tell you about a day they had that was hard and how they got through. That helped me in the beginning stages of everything – hearing how it was ok to have a hard day, and how one day at a time helps you gain strength,” Linda says.

“Every one of us wants the same thing: to stay clean. This group has just been amazing. It’s helped push me through my recovery and there’s no looking back. I’ve made it through with God leading me, guiding me and giving me strength. I’ve overcome my obstacles. I am strong and I continue to rise. And that’s my story,” she adds.

Continuing the journey

The challenges of parenting while in recovery don’t stop at childbirth. “Pregnancy in all trimesters can induce the full emotional range from elation to devastation. This can create vulnerability to drug use for people with substance use disorders. Much of our work in addiction and recovery care focuses on preparing our patients to recognize and cope with the exciting and distressing experiences that arise once the child is born,” says Dr. Schenk, an addiction and recovery specialist at Swedish.

“Pregnancy and parenting can come with immense social pressure, including complex internalized expectations of what it means to be a good parent. A pregnant person or new parent may feel stigma and shame. Both strongly correlate with relapse vulnerability,” he adds.

“The early postpartum period, in particular, is often a time when birthing people face social scrutiny and condemnation,” explains Dr. Schenk. “But the risk doesn't fade soon after birth. At six-to-12 months postpartum, opioid overdose rates have been shown to spike as much as four times the rate overdose in the third trimester. By extending our postpartum services through the OB Outreach Outpatient Clinic, we are able to accompany parents and their babies through these months and sometimes years of vulnerability, healing, and growth.”

Maria

“Once I found out I was pregnant with my son, I luckily stumbled across Swedish through their OB outreach program,” says Maria, who recently celebrated a milestone recovery anniversary. “I have experienced care in a way that I hadn’t experienced before. There’s always been no judgment here. I’ve been supported in ways I truly didn’t know I needed to make it through.”

“In retrospect, I can look back and think about all the times l was able to get through stuff because of decisions that I made that were so scary and so hard. And I really do feel like each moment built up to the next one. And though some things were really, really, really hard, they’ve truly made me who I am today,” she adds.

“When things are rough now, they don’t feel quite as hard as they used to because I know I can go through so much. Hardship taught me so many lessons in ways that I didn’t know were possible. I’ve learned life goes on. And I think that’s very valuable,” she adds. “This group offers support, safety and compassion – we talk about recovery, wellness, we practice mindfulness and we get encouragement, all at once.”

Chemically Using Pregnant Women’s Program

For more than 30 years, Swedish has provided recovery care for pregnant people using drugs or alcohol through the Chemically Using Pregnant Women’s (CUPW) program. The program is available during any stage of pregnancy. Treatment starts with medical detoxification and stabilization, followed by intensive follow-up care and support before, during and after childbirth.

Evelyn

“After being in recovery for a few years, I had the great opportunity to join the CUPW program and I was able to succeed and graduate,” says Evelyn. “The care didn’t stop there. I was able to go to the OB Outreach Clinic. I participated through in-person groups before COVID. We would get together and discuss recovery and motherhood. We would offer support to each other and bring baby clothes. And now we started the Zoom groups after COVID. This is a community for us and we love the connection, the peer support and the interaction with our doctor.”

“I feel comfortable and respected when I am in this group. I see us all as leaders. We all empower each other as well as other women going through what we went through. Being an advocate, going to the events and sharing my story is therapeutic to me. It’s a way for me to lend my voice to something I believe in. I am blessed to be here with all of these women. We’ve grown so much. I remember where we came from and where we are now, it is inspiring,” she adds.

Letting go of secrets

“There can be complicated fallout dealing with an addiction problem when pregnant because it’s such a stigmatized condition. People feel guilty. They’ve been keeping secrets they didn’t want their family to discover. And if you’ve lived with a secret for any length of time, it can be really, really hard to move past that,” says Dr. Walsh.

“Mental health problems of any kind, including addiction, tend to worsen after having a baby. It’s complicated because pregnant people are very motivated,” he adds. “They’re trying really hard but they're also really strained and overwhelmed. And that can trigger cravings.”

Kristen

“I’ve struggled with opioid addiction for as long as I can remember. I had some periods of recovery. But I never really had whole person care and recovery until I went to Swedish and met Dr. Rudolf and all of these amazing women,” says Kristen, who’s been in recovery for nearly four years.

“Some of the greatest things in my life have come from some of the worst things. I was the lowest of the low when I walked through those doors. But now it’s the best decision I ever made. Today, my life looks a lot different,” she adds. “During my pregnancy, I didn't know if I could be a mom. Or if I even wanted to be a mom. I thought there was something just broken in me. And then, of course, the second I gave birth it was like fireworks in my heart.”

“My son is flourishing and he is amazing,” Kristen says with a smile. “He’s really smart and loving. And I get to show up and be a mom to him today. I also have extended family. I get to take part in their lives and continue to see the blessings that brings. Then I get to share it with other women. Sharing those things with each other has brought us so much closer. We’ve talked to each other on pretty unbearable days. Then we get to build each other up.”

Asking for help is the first step

Knowing you need help and having the courage to ask for it can be terrifying. It can also be life-changing, according to Dr. Walsh.

“No matter how dire someone’s situation seems, there's a pathway forward,” he says. “The most important thing is to talk to somebody. For most people dealing with substance use disorder, that’s the scariest part because they are worried about how folks will react. But there are a lot of resources. And if you are willing to reach out, good things start to happen.”

Kimberly

“I have been in recovery for around seven years now,” says Kimberly. “My addiction started when my doctor prescribed pain medication for an ongoing medical issue. At first, I was prescribed a low dose. Before I knew it, I was taking roughly three times the amount recommended for my weight and my size. I didn’t know what to do but I knew I needed help.”

“Shortly after I found out I was pregnant with my daughter I was able to find the outreach program at Swedish. And they are amazing. They don’t judge anybody. They care for us all the same,” she says. “And then as soon as I had my baby, I automatically had a clinic to go to so I could continue in the program. That’s where I met Dr. Rudolf. She’s done a lot for each and every one of us.”

Although telling someone about your substance use while pregnant seems daunting, it’s a vital step in getting the help you need, according to Dr. Walsh.

“Talk to someone you trust,” he says. “That might be your mom or maybe your partner. It might be your pastor or someone at your house of worship. It could be your doctor or your prenatal care provider. It’s terrifying for a pregnant person to discuss substance use but that will get the ball rolling to get the support you need.”

“I think it’s important to remember that people get well,” adds Dr. Walsh. “They are successful. And when they have support, people can do great things. Resources are available to people who are brave enough to reach out for help. And they work.”

Learn more and find a provider

If you or someone you know needs help with addiction treatment, providers in our Addiction Recovery program are ready to help.

Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction, and follow up as needed. If you need to find a provider, you can use our provider directory.

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