One of the best ways to make sure that pregnant women who use substances have healthy pregnancies and healthy babies is to make sure they have good prenatal health care and social supports. These have a huge impact on improving the health of both mothers and babies. Without prenatal health care and social support, women who struggle with substance use during pregnancy are more likely to miscarry, give birth prematurely, or have infants with low birth weights or that have signs of withdrawal. They are also more likely to have their children removed from their care.  Here are ten fundamental principles of working with pregnant women who use substances.

1. Being respectful. Respect is a key building block to support healthy pregnancies and prevent FASD and other drug related harms.  Respect means you are able to create a non-judgemental environment. This means women feel able to openly discuss their experiences and substance use.

2Taking a relational approach. Women thrive when they feel connected to others. This is central to a woman’s growth, development, and the way she sees herself.  If she has a positive, trusting relationship with you and other service providers, she is more likely to stay connected with your program. And the more connected she is, the more likely she will be healthy and have a healthy pregnancy. For more information about this topic, go to the Strategies section of this site, here.

3. Helping women be self-determining. Women have the right to both decide on and lead their own paths of growth and change. You contribute to healthy pregnancies when you support a woman’s right to make her own decisions (even though you might wish that change would happen more quickly). And this helps prevent FASD and other drug related harms for unborn babies.

4. Taking a woman-centred approach. This means that you see that women’s health is just as important as prenatal care to prevent FASD and other drug related harm. Women-centred care supports a pregnant woman’s overall health and safety.

5. Accepting harm reduction goals. Everyone agrees that it is best for women not to use alcohol and other drugs during pregnancy. But sometimes pregnant substance users can’t quit their substance use. That’s when harm reduction or a “small steps” approach can be very helpful. Even if a woman continues to use substances during her pregnancy, any improvements she can make to her overall mental and physical health will improve her health and the health of her baby. These improvements can range from regular meals to reduced substance use to giving Subutex to pregnant opiate users. It’s important that pregnant women are able to get good food, health care, and social support, even if they continue to use substances.For more information about this topic, go to the Strategies section of this site, here.

6. Being trauma-informed. There are many complex links between experiences of trauma and violence with substance use. In our communities, the reality is that many women will have experienced trauma. So service providers need to understand how trauma and violence affect women’s health.  And you understand how substance use can be an attempt to cope with her feelings. For more information about this topic, go to the Strategies section of this site, here.

7. Promoting cultural safety. This is directed primarily to non-Aboriginal service providers. Women who seek help from service providers need to feel respected, safe, and accepted for who they are, with regard to their cultural identity. Non-Aboriginal service providers must recognize the influence of history, colonization, residential school trauma, and other social injustices on Aboriginal people.

8. Supporting mothering in its many different forms. Losing custody of a child has devastating impacts on women. Service providers need to support a range of models for mothering, including part-time parenting, open adoption, kinship and elder support, shared parenting, and inclusive fostering.  Women need support and time to transition from pregnancy to their role as mothers.

9. Promoting health in a broad way. Substance use is not the only cause of problems for mothers and their children. Poverty, trauma and violence, stigma, racial discrimination, lack of access to good food and prenatal care, experiences of loss or stress, isolation, and inadequate housing are all risk factors. If you can provide practical supports for any of these needs, you contribute to preventing FASD and other drug-related harm.

10. Taking disabilities into account. Pregnant women who use substances may also have disabilities, including FASD. It’s not just children who are affected by FASD. Women also might need care that is FASD-informed.

Want more information about how to support healthy pregnancies and healthy babies by supporting women? Check this out:

10 fundamental components of FASD prevention from a women’s health determinants perspective