Pregnancy, Childbirth and Addiction with Guest Lyndsay Ward

Around ten percent of all live births in the United States involve some level of prenatal exposure to illegal substances and as this week’s guest, Lyndsay Ward, puts it, addiction is an equal opportunity offender. Tune in to hear Tina, Serena and Lyndsay talk about the intense stigma surrounding substance abuse, the barriers to care and why moms struggling with addiction need support rather than shame.

Notes and Mentions


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Transcript

Serena: Hey Everyone, I’m Serena.

Tina: And I’m Tina and we are the Mental Health Mamas.

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Serena: Welcome to No Need to Explain, we are so glad you’re here.

Tina: First, as always, a quick disclaimer.

Serena: We come to you NOT as mental health professionals or experts in the field, but rather as the parents of kids who struggle with their emotional health.

Tina: If you or someone you love is experiencing a mental health crisis, please seek professional support. You’ll find a variety of resources in our show notes and on our website, NoNeedToExplainPodcast.com.

Serena: I think I’ve shared before on the podcast that each of my kids were born in different places. My first was born in Colorado, my second in New Mexico and my third in New York. What I know is that the birth experience is something that you always remember as a mom, right Tina?

Tina: Yes. Lots of excitement. Absolutely remember every minute of it. My two were also born in two different states, four years apart and the experiences were vastly different for lots of reasons.

Serena: So like you my kids were born in different places and I had them at very different points in my life, each of those experiences was very different. There were good moments and bad moments with each experience, but overall I would say I felt cared for and supported. A few years ago I had the opportunity to support a young woman who was having a baby and her birth experience and treatment was so markedly different from mine that it seems important to talk about this and we’ve invited a guest today to help us with this important topic.

Tina: Lyndsay Ward is a Social Worker who has worked in a number of different roles supporting youth and most recently supporting new moms as a full-time Social Worker on the Obstetric unit at a hospital. Lyndsay, welcome to the podcast!

Lyndsay: Thank you for having me!

Serena: So before we dive into this complex and controversial topic, we want to be clear about our approach. We will not be sharing any specifics, but rather general themes so that we can protect the confidentiality of all involved.

Tina: We are also going to steer clear of a moral conversation about substance abuse. No matter how you feel about substance abuse...good/bad/right/wrong/or somewhere in between...we know that it is a challenge faced by many and taking a moral approach does not move us any closer to finding solutions.

Serena: Right. So this is our ask to all of you listening out there. We ask that you do your best to suspend any judgement you might be feeling and allow yourself to approach this information with curiosity.

Tina: So Lindsay, your turn. We’re actually going to ask you to talk! It’s really challenging to find accurate statistics on substance abuse during pregnancy, and there are a lot of reasons for this which we’ll get into in a bit. It does appear that around 10% of all live births nationally involve some level of prenatal exposure to illegal substances. Can you share a bit about what you’ve seen personally and if this aligns with your experiences?

Lyndsay: Oh, absolutely. I have definitely worked with people from every walk of life who have struggles with addiction. Addiction doesn’t care where you live, how much money you make, what color you are. It is an equal opportunity offender. When you think about the stereo-typical mother who’s pregnant or who has had children and who uses, it’s not what you see in the real world.

Tina: Yeah. An equal opportunity offender. Is that what you called it?

Lyndsay: Yeah.

Tina: Yeah. I think that we do have certain biases and we think it’s a certain person that comes from a certain place and that just isn’t the case, is it?

Lyndsay: No.

Serena: Yeah. So, knowing that we all have tools or what we might refer to as “coping mechanisms” that we look to when we are struggling. What we know is that some of us have what I would think of as an overflowing toolbox to reach into for support while others might just have a few tools to choose from. They all serve the same purpose, but I would say that some are more socially acceptable than others. Can you talk about some of the stories you’ve heard? For example, why might a mom be struggling with substance abuse?

Lyndsay: I mean, like you guys said, we all have coping skills that we use when we’re struggling. Nobody wakes up one day and is thinking, you know what would be super fun? To just get addicted to heroin. Or to get addicted to any substance. Nobody wakes up and thinks that's what they want to do for the rest of their lives. These are people who, their other coping skills weren’t effective, they still were feeling those feelings and struggling and they turned to something that turns off those feelings and turns off that struggle. I know we talk about substance use, we’re all like, we would never, ever do that. How can a mom do that to herself or her baby? But really, a mom who is utilizing heroin or cocaine is no different than the mom who drinks a glass or two of wine a night to de-stress. It’s all about how we’re perceiving that and what’s acceptable. No one would pull me aside and say, hey listen, Lyndsay you really need to cut back on that morning cup of coffee. It seems like it’s not doing you a whole bunch of good. But if I had a pregnant person in front of me who was using, the first thing that someone would say is, you need to stop using. So it really is about our universal first thought of, how could they do this? What are they doing? And not why is this the only coping skill that seems to make things OK for them.

Serena: Yeah. And what I have certainly witnessed is the idea of generational traumas. So, you know, being born into a system. I’m thinking of a baby, right? That baby grows up and has children and they don’t know anything other than what they’ve lived, right? And the idea that…can they choose? Are they able to…is there any other path than what they’ve grown up with?

Lyndsay: Well I just think when we’re taught coping skills, there is usually a presence saying, this is not the healthiest skill to use guiding us. Like you guys said. When you see that generational trauma, they don’t have that opportunity. And when you think about your support network, you can turn to a friend and say, hey, I’m really struggling with this. But people who are actively using, when they’re sober, they lose that support network.

Tina: Tell us about how newborn babies are tested for substances, in your experience. Are all babies tested or is there something that triggers the testing? And also, last part, if there’s a positive result, what happens next?

Lyndsay: So in terms of testing, I would say that every birthing center is different. When I first started at the birthing center that I was working with, they were not doing universal tox, they were only doing urine toxicology for moms who have history. So that in itself can lead to a complete bias and complete mistreatment. If a person looks, again how a person thinks a person looks who uses drugs, they got tested. So one thing I and my team implemented was universal testing for mom so mom comes in, and if her screen is negative then we wouldn’t do a screen on baby. If her screen is positive, we would then do a urine screen and a meconium screen on the newborn. Urine tells us kind of the past 24ish hours but meconium goes back four months so those results will tell us if mom used any substance in the past four months. If those are positive, as a mandated reporter we call that into children protective services and then CPS follows up from that point.

Serena: So clearly the safety of the child is the priority and we would never suggest otherwise while at the same time I would say there is always room for improvement. It sounds like you did establish some changes in policy but what else would you like to see done differently?

Lyndsay: I would love to see more harm reduction being offered. I think so often you have a birthing person going into the OBGYN and they are using and the first thing that provider is telling them is you need to stop using or I will not see you if you are continuing to use. Instead of saying how can we get your use down from 7 days a week to 6 or how do we get you to use 5 times per day instead of 6 times per day. I think harm reduction instead of abstinence is a lot more realistic for this population. It still binds them to their support network and I mean who–I know ultimately society is the person who says whether their support network is a healthy or unhealthy positive or negative. But in the moment, are we really the ones who should be judging that? I would love to see the counties or the CPS workers who know these birthing people start having more one on one interactions when that person is pregnant again so that they can offer those harm reduction services. They can try to get that mom into a rehab before she has the baby so that when baby is born, mom has been sober for several months and there’s a higher likelihood that mom will be able to take that baby into sober living with her. I would also love to see OB/GYN offices offering more services to people who are struggling. I think sometimes the human in us gets pushed to the wayside because of making sure people go to their appointments, making sure that you don’t have a lot of cancelations. But in the times of COVID how would we expect a single mother of five to get to her OB/GYN appointment when she can’t bring her children?

So I really think the key is more support. We live in a county that is rich in new ideas and out of the box thinking so I would love to see that implemented in more professional settings.

Tina: Yeah, that’s awesome. It sounds like we need to break down systems and come up with new ideas. For sure. Let’s take a moment to talk about what really feels like a no-win situation for these women. From what you’ve seen, do women start using during pregnancy or are they struggling with addiction prior to becoming pregnant?

Lyndsay: I think people are really struggling before they become pregnant. I think pregnancy either makes those struggles worse, depending on their previous experiences or how they got pregnant. Or they can kind of set that motion into sobriety. Like I said, people aren’t just waking up and choosing to be addicted. People use because it makes them feel better. Not necessarily good. Not necessarily bad. Just better than what they’re feeling when they’re sober. And that could be for an unknown amount of reasons. Any kind of trauma in that person’s life. If they’ve had a history of removal of their other children then they get pregnant and the first thing people are thinking is, how do I keep this baby? Or I don’t want to lose this one too. So I have not met a woman I’ve worked with who became addicted during her pregnancy, not to say it doesn’t happen, it’s just not my experience.

Tina: Thanks for that. So, you’re very well credentialed but we know you’re not a doctor, but is it true that there are certain drugs that once pregnant, if you stop using you are likely to harm the fetus?

Lyndsay: So yeah. I am definitely not a doctor but we do know that whatever a pregnant person is consuming, that fetus is also being exposed to. So I think many women try to quit using when they find out that they’re pregnant but those withdrawal symptoms are so significant that they really struggle. And their frame of mind is, is it better to continue to use so my fetus doesn’t withdraw? Or do I have to withdraw myself and deal with my unborn child withdrawing? I don’t know of any specific drugs that can cause more harm to the fetus. I think when you’re looking at women who would seek assistance, it’s women who are looking for those reductions in withdrawal symptoms or cravings. So you’re looking at women who are seeking out Suboxone or Subutex but even those have side effects. It’s not a perfect science any time you introduce a new substance into your body, you have to consider what it will do to the fetus. But sometimes relapse, part of the disease, just happens as a way to cope with feeling like, what can I do so that my baby has the best chance of surviving this pregnancy? And it might not make sense to us as we’re talking about it but the frame of mind, people struggling with addiction have, does not make sense.

Serena: Yeah and I think the other thing that we haven’t mentioned and I don’t know what you see in terms of age ranges of these moms, but the idea that we know that our brains are not fully developed now until at least (we now know, I should say), until at least 25. And I could imagine that a lot of these moms are younger than 25 which means, one, they’re not, they’re brains aren’t fully developed. And two, the substances that they’re using are rewiring their brains, right?

Lyndsay: Oh, absolutely. I think if you look at, let’s just say the average age of having a baby is 28. If you say this 28 year old person comes in with a ten year history of use, in that ten years, what has happened to their bodies and brains because of that use? We obviously know, studies show that consistent alcohol and substance use rewires our brains and causes us not to have everything that the typical (and you can’t see me but I am using air quotes for typical) person has. I think it’s just such a complex situation where, how do we treat trauma, rewire the brain, teach a new coping skill, all while this person is pregnant.

Serena: Mmhm. Yes. Growing a human being.

Lyndsay: Right, exactly.

Serena: Which is no small thing on its own. Given all the stigma around substance abuse and pregnancy, I can imagine that this puts women into the position of not wanting to be honest with their providers or perhaps not wanting to seek appropriate care out of fear of whatever the consequences might be. I am just curious, is this something you’ve seen?

Lyndsay: Oh, absolutely! A lot of the women I have worked with, it’s not a phrase I like to say, but they hospital jump where they will have a baby at one hospital and CPS has been involved so when they get pregnant again they go to a different hospital not necessarily realizing that if they’ve received prenatal care, that stuff is noted in their chart. But also if you’re having a really great experience with an OB and then you state, oh yeah, I was sober and then I relapsed, their whole perception of you can feel like it’s changed. And these are women who have already been so harshly judged by everyone around them that they don’t want to open themselves up to that. Or they are supposed to be sober living and they’ve been using and it just has gone under the radar and now they come in to have their baby and they have a positive toxicology. I think it’s difficult because…so we as humans have this need to put everything into boxes. Like you’re pregnant so you can’t drink, you can’t do drugs, you can’t smoke cigarettes, you can’t eat hot dogs, you can’t eat deli meat. If you do any of that, you’re terrible. But I can promise you that no matter how hard we judge, doctors judge, whomever judges this person, no one is judging that mother harder than she’s judging herself. I cannot tell you how many times I’ve sat with a mom who has a baby going through neonatal abstinence syndrome who is sitting there telling me how awful she feels and how she doesn’t even feel she deserves to have her baby because she’s put her baby through this. What good does it do to be like, yeah, you’re right. It doesn’t do any good. It doesn’t promote trusting relationships. It doesn’t give that mom confidence that she can get sober or that being sober is worth it.

Tina: Yeah, so I guess I was just gonna say I feel as though this is a bit normal, right? We all wonder what it is, we, we who have children who struggle with their mental health, right? We often say, was it something we did? Was it something we did during the time we were pregnant? So I’m totally relating to that piece of it, right? And it’s hard. It’s hard to grow a human being.

Serena: It is!

Tina: Under any circumstance. Yes. So let’s think about…you’ve talked about how you might change the world and we’re going to bring up this study from the University of Massachusetts at Lowell. It is titled Pregnant Women and Substance Use: Fear, Stigma and Barriers to Care, (we will link to it in our show notes), and I quote, “The results suggest that punitive policies have indeed had some chilling effect on women’s help-seeking behavior by discouraging women from accessing prenatal care or leading them to skip appointments, and by motivating women who did attend appointments to withhold medically relevant information about their substance use. Some women were honest with medical professionals but then experienced poor treatment, making them less likely to be honest again in the future. Women also shared their experiences accessing substance use treatment. The benefits and drawbacks of different treatment options were discussed, as well as the barriers women encountered as they searched for and received treatment.”

And the article continues by saying...

These findings demonstrate that women are in need of more treatment options, better access to the treatment of their choice, and more support for staying in treatment.”

Do any of these thoughts resonate with you?

Lyndsay: Oh absolutely! I have heard from many of the people that I have worked with that they have felt that they were treated significantly different after disclosing current use or history of use. I think, you know, some offices are offering more services. But it is still an area where it is really difficult not to fall into that mindset of, “if you love your baby you wouldn’t be using whatever substance you are using.” And I would love to see that mindset changed from, “how could you do this” to “well why?”. What has happened in your life that this is the only thing that makes you a better person in your mind? I just think about how strong someone has to be to say, “I am addicted. I want to get sober but where do I start? Where do I start getting sober and what does sobriety look like for me?” And I think one thing that really is unfortunately that I learned through working in a birthing center that is a lot of the rehabs offered to women who are pregnant or have children actually have a timeframe for when their newborns can join the person seeking help so for the longest time, and I can be the first to admit, I was giving misinformation. I was telling these woman, “ Oh yeah, you go to this rehab and you get your baby and the more research I did about it it was, most facilities make the mom stay there 30 days with no physical contact with the child so they can show commitment to sobriety and then they get one weekend a month of supervised visitation with their child then they get two weekends a month with unsupervised visits and they don’t get overnights until 4-6 months. Imagine that. Imagine already feeling that you have already lost your baby or that you have lost your other children and you agree to go to this rehab under the thought you will get your baby and you don’t get your baby until maybe 6 months? That is insane to me. And I really think that if there were more facilities that said, “Alright! Let’s get you in with your baby.” You would see a huge increase in moms wanting to go to rehab to get sober to keep their children.

Tina: These are just humans growing other humans and we need to be….yes we need to protect children and we need to try to do the best for other humans, right?

Lyndsay: Absolutely and I know, again like we said at the beginning of the show, this is a very controversial topic. But studies have actually shown that when you have a baby who is born and has substances in their system they have actually done better when they are skin to skin with mom, when they are being consoled by mom, when they are in the same room as mom as long as that is medically possible. So I think taking some of the medical research and putting it into practice, you would see an increase in people wanting to get these services.

Serena: Right and we also know that those first few months are crucial for the bonding between mom and baby. You can’t replace it.

Lyndsay: Nope.

Serena: Yeah. That is so incredibly hard to imagine. So given our discussion today and all of the challenges faced by not only the women struggling with addiction but also the people supporting them, I am curious, how can we move closer to a better future? How can we better partner to support all involved?

Lyndsay: I always go back to the golden rule of treat others how you want to be treated. At the end of the day, the only thing that separates someone who is addicted to drugs and someone who’s not addicted to drugs is an opportunity.

Serena: Lyndsay. Say that again.

Lyndsay: The only thing that separates a person who is addicted to drugs from a person who is not addicted to drugs is opportunity.

Tina: Do you want to say it again Serena? Seriously! We could say that 100 times.

Serena: We could. We could.

Lyndsay: It is so crazy to think about because when I was younger I didn’t have a ton of exposure to a bunch of illegal drugs, I think maybe just marjuanna. That was like the end of my exposure, right? And then that varies so differently from someone else. And when you look at like…so I had a baby and I wasn’t using and I didn’t have any issues but really what separated me from the woman next to me who was struggling. Nothing. One opportunity was all it takes.

Tina: So what we know that you are working hard to change things up to make things easier for both mamas and for hospital workers and for babies. In that hard work we know that compassion resilience and renewal for those who care for others is SUPER important to stave off burnout. What are you doing to take good care of yourself Lyndsay?

Lyndsay: I watch really really bad reality TV. Like I try to find something that is completely mindless. For a longtime it was Jersey Shore because I could watch that and be like, alright, this is not stressful to watch, I don’t really have to think too much about this. I also read A LOT. My husband often says I read more in a week than he had read in his entire life. He would also tell you that I am not the best at self-care so I am still working on it.

Tina: I don’t think we are all experts. We all need more practice. For sure!

Serena: So before we wrap up, we wonder if there’s anything we haven’t asked you that you’d like to put out there to the world?

Lyndsay: Just like I said, be kind to one another. We are living in a crazy time where every time we think it is going to get better it doesn’t. So I really think that people are struggling more with mental health issues and turning to substances. I just read a study about how more adolescents and young adults are turning to drinking more as a way to relieve stress. We need to be checking in on our people, checking in on our tribe. Making sure we are not just taking someone’s–when someone is saying, “Oh no. I am good.”

Are you really good? I know that when I was employed at a hospital that’s one thing that I always asked people, “ Are you really good?” It caught people by surprise because when you ask, “Oh, how are you?” The first thing that goes to your mind is, “well, I am good,” because they don’t need to be bothered with my problems. But it is Ok to be bothering people with your problems. That is what I want to tell people: Bother people with your problems. Otherwise you will explode.

Tina: Well I love that. And I love the suggestion of building your support network in unlikely places. Right? Ask people, be the catalyst who says to somebody, “Hey, I want to connect. What’s going on?” Right and really showing that you are a human that cares about other humans. Awesome. Lyndsay, thank you so much for joining us today and sharing about this super important topic and all of the work that you’re doing to truly make the world a better place.

Lyndsay: Thank you so so much for having me. I was SO excited to do this!

Tina: So podcast friends, we are, as always, grateful for all of you listening and supporting us. You can help us out by visiting Apple podcasts, leaving us a review, subscribing and please share with others. You will find more content on our website, NoNeedtoExplainPodcast.com. You will also find an email address there and we would love to hear from you by email. And as a quick reminder it’s not too late to claim our free self-care workbook knock knock Lyndsay you can claim our self-care workbook by signing up for our mailing list which you can do right on our website.

Serena: And this is your gentle reminder to take good care of yourself while you are also taking care of your people.

Tina: Thanks again for listening!

Serena: Bye!

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