Information to be obtained about drug use should not be limited to merely what drugs a birth mother used. The timing of her use of a drug is key. Drug...

A familiar saying claims that what you don’t know can’t hurt you. For prospective adoptive parents to apply this advice to their adoption journey is simply not prudent. In order to determine what match opportunities to pursue and to be adequately prepared to parent the baby to be placed with them, they need to know details about the birth mother’s behavior during her pregnancy. In particular, a birth mother’s use of drugs while pregnant is crucial information for prospective parents not only to have, but also to understand. Here are nine things of which hopeful new parents should be aware.

1. Drug Use May Not Be Disclosed by the Birth Mother

Prospective adoptive parents will never have as much information as they desire about any match opportunity. Gaps in information are inevitable. Perhaps the child was conceived as the result of a casual, one-time encounter, and information on the birth father is limited. Perhaps the birth mother is estranged from her family and cannot contact relatives to obtain family medical history. These are situations where the birth mother does not have the information to convey. But when it comes to prenatal drug use, the birth mother has information but may prefer not to disclose it.

Why wouldn’t a birth mother want to provide key information about her health which would affect her baby? To answer this question, prospective adoptive parents need to put themselves in the birth mother’s shoes. There are several reasons why the birth mother may refuse to disclose or even outright lie about her drug use; these reasons make sense to her because they impact her.

If a birth mother has chosen an adoption plan, then she wants to make sure a good family takes placement of her child. From her perspective, she may be concerned that adoptive parents would reject her child if she confesses to her use of drugs while pregnant. Perhaps she thinks no one will want the child under these circumstances, and she is not in a position to parent.

Another reason to fail to disclose prenatal drug use is that the birth mother fears legal repercussions. If she is on probation, evidence of her use of drugs would be a violation—which could send her back to jail. If the birth mother has other children, she may fear losing them; removal of her children from her is a possibility if the state learns of her drug use which might impact her children’s safety.

The birth mother may also be embarrassed by her drug use. Perhaps she was simply experimenting with drugs or was going through a difficult time when the drugs were used. She might feel that prospective adoptive parents will judge her or think less of her for admitting the truth about what she has done.

2. Birth Mother’s Drug Use May Have Been Without Awareness of Her Pregnancy

A large number of the cases where adoptive placements are made involve unplanned pregnancies. If a birth mother was not planning to get pregnant, then she probably is not considering the possibility she is pregnant as she goes about her life. She may have smoked cigarettes, consumed alcohol, or used illicit drugs without any inkling that she was with child.

The unplanned nature of a pregnancy is important for adoptive parents to consider for several reasons. First, the birth mother was not willfully ignoring the health of her baby because she did not know there was a baby. Second, if the birth mother was unaware she was pregnant, she did not contemplate restricting her activities to protect a baby. Thus, she felt free to binge drink or chain smoke, for example. Third, lack of awareness of a pregnancy means a woman is paying less attention to what she is doing than she would if she knew she was pregnant. The birth mother probably is not counting the number of drinks she consumed, cigarettes she smoked, or pills she popped. Thus, getting precise information about the frequency and amount of a drug she used is not likely.

3. Whatever the Birth Mother Uses Is Transmitted to Her Baby

No man is an island, and neither is a pregnant woman. The actions she takes can and will affect her unborn child. The fetus is connected to the mother by the placenta and umbilical cord. The birth mother is not only eating for two, but she is also drinking and breathing for two as well. What goes into the mother’s body is shared with her baby. Alcohol, for instance, crosses the placenta easily.

Because a fetus is developing, it cannot eliminate drugs used by its mother as effectively as the mother can. Chemicals can thus build up to high levels in the baby and can cause permanent damage.

4. The Timing of Drug Use During the Pregnancy Is Important

Information to be obtained about drug use should not be limited to merely what drugs a birth mother used. The timing of her use of a drug is key. Drug use early in the pregnancy can affect a fetus’s developing limbs and organs. The fetal organs form during the first two months of pregnancy, so exposure to a harmful drug during this time can cause the most serious birth defects.

Unfortunately, early in the pregnancy is when a woman is the least likely to be aware that she is pregnant. Once she’s aware of her pregnancy, a woman may discontinue use of alcohol, tobacco, and drugs; however, the damage may have already been done at that point by her drug use prior to such awareness.

When a woman is visibly pregnant or has learned that she is pregnant, continued use of drugs is a decision she makes despite awareness of the damage it might cause to her developing baby. Use of drugs later in the pregnancy, just as early in the pregnancy, can be harmful to a fetus. At later points, the negative effect will be on the development of the central nervous system which is comprised of the brain and spinal cord. Birth defects of the central nervous system are called neural tube defects. Spina bifida is one such birth defect.

5. Use of Illegal Drugs Means a Greater Risk for the Pregnancy 

There are risks involved with any pregnancy, but a pregnancy impacted by illicit maternal drug use is at a higher risk. According to the National Institute on Drug Abuse, if the birth mother is a drug addict, her drug use can increase the chances of several serious complications. Studies have shown a much greater risk of miscarriage, low birth weight, birth defects, premature labor, fetal death, and learning and behavioral problems where prenatal drug use has occurred. Research has also established that illegal drug use by pregnant women can significantly increase the odds of complications and health issues for both the baby and the birth mother. For example, such drug use during pregnancy can double the risk of stillbirth.

6. It’s Not Just Illicit Drugs with Which to Be Concerned

Drugs which are dangerous to the baby when taken during pregnancy are known as teratogens. These drugs can produce birth defects or even end a pregnancy. When drug use by a birth mother is mentioned, people typically envision use of illegal drugs. But even drugs legally obtained or prescribed can be teratogenic.

According to the Cleveland Clinic’s Medicine Guidelines during pregnancy, “no drug can be considered 100% safe to use during pregnancy. Pregnant women are urged to consult with their healthcare providers about the continued use of prescription drugs once they learn they are pregnant. With these guidelines in mind, prospective adoptive parents need to know about ANY drug used by the birth mother during the pregnancy, illegal or not.”

The most frequently used drug in pregnancy is one which is readily available at grocery stores and convenience stores. That drug is nicotine, and it is contained in cigarettes. Babies whose mothers smoke during pregnancy are likely to have a lower birth weight.

Alcohol is also legally available to birth mothers who are of drinking age. There is no known safe amount of alcohol. Risks from daily drinking or heavy alcohol use are well-established. Drinking alcohol is a leading cause of mental retardation; its consumption may also lead to fetal alcohol syndrome (FAS).

A group of disorders called fetal alcohol spectrum disorders can result from a birth mother ingesting alcohol during pregnancy. These disorders may be caused by such consumption at any point in the pregnancy.

Even prescription drugs which are legally obtained and properly used may be dangerous during pregnancy. For example, medications prescribed to treat or control epilepsy can contribute to the risk of neural tube defects. Lithium, which is primarily prescribed for bipolar illness, is associated with higher fetal cardiovascular malformations.

Some pregnant women will require drug treatment while they are pregnant because they suffer from chronic conditions such as diabetes, asthma, and high blood pressure. Withholding drug treatment during the pregnancy could be dangerous for both the birth mother and the baby. Accordingly, it is not possible for a pregnant woman to simply cease taking all medications while pregnant.

7. Testing May Be Utilized to Determine Maternal Drug Use 

When a birth mother is not forthcoming with information about drug use during pregnancy, tests may be utilized to identify prenatal drug exposure. An obstetrician can order a drug screen to identify such use; unfortunately, many birth mothers using illegal drugs will not seek prenatal care, or at least not regular prenatal care, for that very reason.

Post-birth toxicology tests may be run on the infant’s urine and meconium (first stool) to assess possible drug exposure. Urinalysis can be completed fairly quickly, but it typically provides results of exposure only for the preceding few days. Meconium screening, on the other hand, can identify substance exposure for the past several months, but obtaining those results often takes several days.

8. Drug Use During Pregnancy May Lead to Fetal Dependency

A birth mother’s regular use of a drug during pregnancy may cause fetal dependence on it. Neonatal abstinence syndrome (NAS) can result following the baby’s delivery when he is no longer receiving that drug through his mother. Some drugs and medicines are more likely to cause NAS than others are; the syndrome applies most often where opioid medicines have been taken.

When a baby has become dependent on a drug through exposure in the womb, he suffers withdrawal when he does not receive the drug post-delivery. Withdrawal symptoms may begin as soon as a day or two following delivery; however, they can also start five to ten days later.

Symptoms of NAS include irritability, trembling, fever, seizures, and rapid breathing—among others. NAS symptoms can vary depending on what drug was used, when the birth mother last used it, and whether the baby was premature or full-term. When more than one drug was used by the birth mother, the symptoms are often worse.

Healthcare professionals most commonly use the Finnegan Neonatal Abstinence Scoring System to assess the signs and severity of withdrawal in a baby. Using this standardized scoring tool allows the appropriate treatment regimen to be devised by attending medical staff.

9. Birth Mothers May Continue Drug Use Following Delivery

If a birth mother is using drugs regularly during her pregnancy, that behavior could continue following the birth of her child, especially if she is an addict and does not seek treatment. While an adoptive placement of her baby removes the child from the birth mother’s custody and regular presence, her drug use must be considered when determining what, if any, post-placement contact will occur. With open adoptions being a common arrangement, prospective adoptive parents could be faced with the scenario of a meeting with a birth mother who is high, drunk, or in poor physical (and perhaps mental) shape as a result of her substance use. A post-placement contact agreement should address what restrictions or prohibitions for future contact apply if drug use continues.

Prospective adoptive parents routinely ask about a birth mother’s due date and the prenatal care she is receiving. Another key question for them to pose is what drug use, legal or illegal, has occurred during her pregnancy, including what the drugs were and at what point they were used. Awareness of this drug use is important because such use may make the pregnancy at more risk or result in fetal dependence following birth. Information about maternal drug use may not be revealed by the birth mother who could have used drugs without knowledge that she was even pregnant or who fears repercussions should she confess to such use. Drug use by birth mothers during the pregnancy is a negative, but the situation is made worse if prospective adoptive parents are unaware of that use and are not prepared to deal with what the consequences of such use might be. Ignorance of the circumstances of maternal drug use is not bliss.