Alcohol & Pregnancy

Woman and alcohol – barriers to asking for help  

Motherhood is a social and cultural construct that determines how children are raised and who is responsible for raising them. Once a woman has taken on this role, it will often be viewed as her master status i.e. one that dominates all others and thereby defines her social position. The expectations that surround this role are extremely high and are commonly viewed as ‘natural'. Consequently as a result those who do not match those expectations are often viewed as unnatural or have having failed.

Substance-involved mothers present a special set of challenges for AOD professional, not only because of their unique clinical histories and experiences, but also because of their role as mothers and caregivers. Women's parental and care giving roles have not traditionally been the focus of substance abuse treatment, even though substance abuse clearly has an impact on a woman's ability to parent.
[Tracy and Farkas ]

A pregnant woman using alcohol or drugs may also be vilified by her community, as explained by Broom and Stevens (1993):

Women who are problem drinkers or use illicit drugs have been construed socially as different or more abnormal than men who engage in the same behaviour. Considering norms of appropriate femininity and masculinity, it becomes apparent that an addicted or alcoholic woman is doubly deviant: she has transgressed not only the law or general social convention but she has specifically violated the norms of being a ‘good woman'.

With the production of healthy, happy children as one of those norms, the above account suggests that a pregnant woman using alcohol or drugs is seen as highly abnormal in society. Further, when pregnancy is included in the context of an alcohol or drug misusing client living in a rural area with small, close knit populations, the task of delivering timely and effective antenatal care becomes more problematic, and the level of stigma may increase.

Professionals can lack confidence in asking women what might be seen as ‘sensitive questions' about their drinking. Drinking would not be explored in any depth if the women didn't ‘look like a drinker'.

A primary issue in relation to a diagnosis of FAS/FASD can be the expectations of professionals attached to questioning a mother about her alcohol/drug use during pregnancy. Beliefs vary from

• they won't be truthful
• they won't be accurate
• the diagnosis will cause them to feel shame and guilt, so what is the point?

Whilst these beliefs are understandable, they are not helpful in delivering early intervention and limiting the costs FASD can place on child development and the impact on the family.

Something to think about

FAS is now recognized as the foremost non-genetic cause of intellectual impairment (Abel and Sokol 1986a and Hannigan, 1995, in O'Leary, 2002). A blunt question in relation to diagnosis would be how many children who are being diagnosed with ADHD or some other behavioural disorder actually have FAS/FASD? It is an area for future research and an emerging thought in light of these basic facts:

• levels of binge drinking have increased in women
• there are increasing numbers of children being diagnosed with ADHD and other behavioural disorders

International studies indicate that 1 in 100 children may be affected by severe to mild alcohol related disorders
[Alcohol in the Womb Conference Flyer October 2005]

It has been estimated that 1 in 20 children suffers behavioural disorders such as ADHD, for which Ritalin is prescribed. Figures from the Prescriptions Pricing Authority reveal that there has been a 180-fold increase in prescriptions for Ritalin since 1990.
[Telegraph September 18 2005 ]

This is an area which clearly needs to be looked at in more depth. Whilst local maternity statistics give extremely low numbers of children who are diagnosed with FASD, further down the reproductive cycle other services are clearly dealing with a number of children who

• have behavioural problems themselves
• are affected by parental substance use in different ways

Are we to assume then that women stop drinking and using substances during pregnancy, only to resume at a later date and this is when the problems arise? Statistics would suggest otherwise. Or should we accept the fact that there are a number of women whose use of alcohol and/or drugs whilst in the pregnancy phase of the reproductive cycle will have implications for their child further down the line and that they are not being picked up for a variety of reasons

• fear of disclosure (a common belief being that you will have your child taken away)
• current ante-natal screening ineffective
• focus on the full blown FAS particularly dysmorphic features as opposed to FASD
• common belief being, no dysmorphic features – no FAS

As stated in the philosophy behind this website we hope to encourage a more open and comprehensive analysis of what is actually happening in Scotland today.

Reference: ‘Sometimes when you're on heroin or drinking they think you don't care' -A needs assessment with health care services for women with alcohol and drug problems in Aberdeenshire

Anni Stonebridge
Jane Livingston
Aberdeenshire ADAT
October 2005