Depressed, Pregnant Women Receive Inconsistent Treatment, Have Longer Hospital Stays

Science News
Depressed, Pregnant Women Receive Inconsistent Treatment, Have Longer Hospital Stays
ScienceDaily (June 16, 2011) — Pregnant women who screen positive for depression are unlikely to receive consistent treatment, researchers say. That may translate to women spending more time in the hospital before babies are even born.
The Obstetric Clinics and Resources Study, published in General Hospital Psychiatry, tracked 20 health care providers in six Michigan clinics and revealed a lack of uniformity in addressing perinatal depression.
“There are a lot of barriers to translating information into everyday practice situations,” said Dr. Christie Palladino, an obstetrician/gynecologist with Georgia Health Sciences University’s Education Discovery Institute and principal investigator on the study. “We wanted to understand what it’s like for prenatal care providers to deal with depression care.”
Providers felt burdened having to make instant decisions about complex issues, the multidisciplinary research team found. And those decisions varied dramatically, even within the same clinic.
“There was no system-level support for providers,” Palladino said. “They felt as if they were making decisions out on an island.”
That sense of isolation, coupled with a lack of direction about how to treat pregnant women with depression, may explain why fewer than half of women who need treatment receive it.
Adding to the disconnect was providers’ discomfort in talking about the disease with both patients and mental health care providers.
“In training, we tend to talk about how frequent a disease is, what the known causes are and the treatments that are available, but we don’t address developing referral relationships,” Palladino said. “We need to focus on not only knowledge of the disease, but also on the intrinsic motivations.”
To address the problem, GHSU’s Education Discovery Institute is conducting a pilot project to teach such skills. Residents and faculty in OB-GYN, psychiatry and pediatrics are collaborating to develop and test tailored educational interventions in perinatal depression care, in hopes of quickly implementing the content into clinical practice.
Palladino is applying for a Health Resources and Services Administration grant to test the curriculum and intervention at other locations as well.
An earlier study led by Palladino discovered that depressed women had significantly longer-than-average hospital stays: more than 24 hours prior to delivery.
“That’s a long time for an otherwise healthy woman to be in the hospital before going into labor,” Palladino said. “It has serious consequences for the mother, for the family and for the hospital system in terms of time and cost.”
The study, published in the Journal of Women’s Health and funded by the Robert Wood Johnson Foundation, also confirmed previous research linking depression to an increased risk of complications such as pre-term delivery, pre-eclampsia, premature membrane rupture and gestational diabetes.
“I was in a fantastic residency program, but treating depression during pregnancy wasn’t even on the map at the time,” Palladino said, noting that many OB-GYN residency programs still lack mental health training. “This has become my passion.”

Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Georgia Health Sciences University. The original article was written by Sharron Walls.
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Journal Reference:
1. Christie Lancaster Palladino, Gina L. Fedock, Jane H. Forman, Matthew M. Davis, Erin Henshaw, Heather A. Flynn. OB CARES — The Obstetric Clinics and Resources Study: providers’ perceptions of addressing perinatal depression — a qualitative study. General Hospital Psychiatry, 2011; 33 (3): 267 DOI: 10.1016/j.genhosppsych.2011.02.001

Newly Born and Stigmatized: NYT Fail on Pregnant Women and Drug Use

Newly Born and Stigmatized: NYT Fail on Pregnant Women and Drug Use
By Lynn Paltrow, National Advocates for Pregnant Women (NAPW)
April 11, 2011 – 9:36pm
Like the early stories in the New York Times about prenatal exposure to cocaine, the recent New York Times story, Newly Born, and Withdrawing from Pain Killers relies on anecdote and innuendo to focus attention on pregnant drug users rather than actual facts, lessons learned, or the real economic and ethical issues that need to be addressed.
One paragraph leads with this alarming characterization: “As prescription drug abuse ravages communities across the country. . . .” When prescription drug use turns into dependency and addiction it can be extremely damaging to the individual and those around them. This piece, however, does not offer one shred of evidence connecting pregnant women’s drug use to community destruction or decay.
In contrast, there is a lot of evidence that communities in this country are being ravaged by unemployment, foreclosures, massive cuts to education, and by the ongoing transfer of wealth to the top two percent of Americans. Moreover, as researcher Ernest Drucker, PhD, documents, these same communities are being ravaged by over-policing and the mass incarceration of young African-Americans.
It is these policies and practices that not only destroy communities, but that also lead some individuals to turn — out of depression, despair and exhaustion – to drugs.
Indeed, the only mother who is given the chance to talk about why she was using drugs said she was introduced to the painkillers “while working the overnight shift at an industrial bakery an hour from her home.” This young mother who must leave her infant at home so that she can commute two hours each day to work an overnight shift said she found the drugs made it “a lot easier to get through life and have energy.”
Sadly, this New York Times story advances a popular and persistent political narrative that blames drugs, and particularly pregnant women’s drug use, on the destruction of communities rather than on our nation’s economic policy which, among other things, forces young parents lucky enough to have any job, to work a night shift far away from their homes and their children.
According to the story:
“Like the cocaine-exposed babies of the 1980’s, those born dependant on prescription opiates – narcotics that contain opium or its derivatives- are entering a world in which little is known about the long term effects on their development.”
This is another example of brilliant obfuscation. Rather than report on all that has been learned since the 1980’s – that the alarm about prenatal exposure to cocaine was never justified and that the predicted massive harms never materialized (facts finally so impossible to ignore that the New York Times, a major contributor to the alarm, ran The Epidemic that Wasn’t), the story suggests that when “little is known” we can, in the meantime blame mom and expect the worse.
The story goes to great lengths to describe newborns with strange cries, and stiff limbs, ones that need to be kept in dark rooms – exactly the same characteristics once ascribed to babies prenatally exposed to cocaine and later found not to be linked to that drug or any other.
The story claims that there is “no universally accepted standard of care for their babies” despite years of work by leading researchers including world-renowned Dr. Loretta Finnegan, who have helped establish such standards. Nor does the story mention the existence of federal pamphlets and guidelines recommending methadone treatment for pregnant women with addictions to opiates as healthful and responsible for both the pregnant woman and the newborn.
Moreover, the story fails to mention research that has found that allowing new mothers to hold their babies and to have skin-to-skin contact significantly reduces signs of neonatal abstinence syndrome and the need for medications. Yet, as written, this story paints a picture of children that must be kept in isolation, away from their mothers, and subject to often uninformed and over-medicalized responses. In fact, there are now decades of research regarding children prenatally exposed to drugs, and the vast majority of studies have either found subtle (small) effects or none at all.
The story also demonstrates how some issues are defined as “ethical” ones and others are not. According to the story, “Few doctors are even willing to treat pregnant opiate addicts.” While the writers of this story claim that those who “treat pregnant addicts face a jarring ethical quandary” about whether to prescribe certain medication to pregnant women, because of the effect it might have on their future children – the fact that most doctors will refuse to treat a pregnant patient begging for help is not described by the authors as an ethical issue at all.
The authors of this story also admit that there “are no national figures that document the extent of the problem,” yet claim that the problem “has grown rapidly,” describing Maine as “plagued” by prescription drug abuse. Such language, totally without supporting data, suggests a far-reaching, fast-growing problem.
National surveys, however, consistently find that at most 3-5 percent of all pregnant women use any controlled substances and most of those women are using marijuana-some to self medicate for extreme morning sickness. Since there is no data, only anecdotes, there is no reason to assume that pregnant women’s drug use has increased or comes close to the numerous other factors that are recognized as far more common and that carry greater risks including, obesity (>20 percent), inadequate prenatal care (>10 percent) and smoking cigarettes (10 percent) and most of all, poverty.
Perhaps then the real ethical quandary that should be addressed is why stories like these suggest that the greatest threat to children is their mothers – rather than the lack of universal health care, the economic policies undermining our communities, and the unethical doctors who turn away pregnant women seeking medical help.

Read NYT article here: link – http://www.nytimes.com/2011/04/10/us/10babies.html?_r=1

Screening at the Adoption: Secret Histories, Public Policies Conference

I recently screened the 79 minute rough cut of Moms Living Clean at the Adoption: Secret Histories, Public Policies Conference at MIT in Cambridge, MA. I was honored to be the first presenter of the conference and a day of documentary films. One might think, what is the link between mothers with addictions and adoption, but a closer look will show that adoption and foster care may be the experience for children of mothers with substance abuse issues, if they cannot stay in recovery, learn parenting skills and become self-sufficient.

The screening was well-received and a lively discussion followed. One adoptive mom told me that for her, my film was the most meaningful workshop at the conference. And I got some good feedback on how to make the film the best it can be.

This was the third bi-annual conference of ASAC, The Alliance for the Study of Adoption and Culture, and was attended by university professors, adoption agency professionals and the general public with a personal or professional interest in adoption. I presented my first film Unlocking the Heart of Adoption about the lifelong process of adoption for adoptees, birthparents and adoptive parents in same race and transracial adoption with illuminating historical background at their first conference in 2005 in Tampa, FL. This is a great group of people and it was wonderful to see friends and make new ones.

Everyone agreed the issues presented in the film need to be addressed now. I am excited to take the film to the next level of completion and getting the funding to make this possible. My goal is to complete Moms Living Clean by Fall 2010 for launch in 2011.

Moms Living Clean work-in-progress screening April 29 at MIT

Moms Living Clean work-in-progress screening:
Thursday, April 29, 2010 – 10:30am-12:15pm
Adoption: Secret Histories, Public Policies Conference
Massachusetts Institute of Technology
Cambridge, MA
followed by Q&A with Sheila Ganz, filmmaker
click here for information and registration

Please let me know what you think about this. Click on the comment link below.

This feature film follows six mothers with addictions on the verge of losing custody of their children. They enter an innovative substance abuse treatment program hoping to turn their lives around. Interwoven with their stories, the film takes an unflinching look at drug laws aimed at pregnant and parenting women with addictions, and the legacy of imprisonment and foster care on children.

This important film will catalyze a much-needed dialogue on treatment vs. criminalization, inspire people with substance abuse issues to begin the recovery process, challenge the stigma against mothers who use illicit drugs, and shed light on the issues for their family and friends, social service providers, law enforcement, policy makers and the general public. Moms Living Clean will make a difference.

If you are unable to attend the screening and would like to support completion of Moms Living Clean you can make a tax-deductible donation in any amount right now through the film’s non-profit fiscal sponsor San Francisco Film Society Thank you.

I look forward to seeing you there!

Sheila Ganz, Director
unlockingheart@hotmail.com

Forum on Substance Use and Pregnancy – April 20, 1010

Community Forum —
“Substance Use during Pregnancy: How can we respond?”

Free and open to the public, no registration necessary

Tuesday, April 20, 6:30 p.m. – 8:00 p.m.
Chrysalis Community Center, 1589 Hill Rise Dr., Lexington, KY

Drug and alcohol use during pregnancy is a problem that raises serious concerns and strong feelings on the part of Kentucky families, elected officials, individuals in recovery, and community members. This Community Forum will provide us the most up-to-date information on the effects of substance use during pregnancy and how we can best intervene to help baby and mom.

Featured speaker Barry Lester, PhD is a leading national expert on the short and long-term effects of prenatal substance exposure on the baby and developing child. He holds the following positions at Brown University in Providence, RI: Professor of Pediatrics; Professor of Psychiatry and Human Behavior; Director of the Brown Center for the Study of Children at Risk at the Brown Alpert Medical School; and the Director of Research, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics. He has published over 200 journal articles and book chapters, many on the fetal effects of psychoactive drugs and the children of addicted women.

Other panel members will include: a local obstetrician, a mother in recovery, and an attorney familiar with Kentucky law regarding pregnancy and substance abuse.

Sponsors: Kentucky Coalition for Women’s Substance Abuse Services; Kentucky Division of Behavioral Health; Administrative Offices of the Courts

REGISTRATION IS REQUIRED!
Email, fax, or mail your name, organization, mailing address, email address, and type of license/certification to:
Justina Keathley, Division of Behavioral Health
351B Perkins Building
521 Lancaster Ave.
Richmond, KY 40475
Justina.keathley@eku.edu
859-622-3084 (fax)

3 Hours of Continuing Education Credits pending for: CLE, CJE, CADC, LPCC, LCSW, LMFT, Nursing, and SA Prevention

For more information contact Lynn Posze lynn.posze@ky.gov, or Fran Belvin fran.belvin@ky.gov at 502-564-4456

Mike Barry at People Advocating Recovery (PAR): mike@peopleadvocatingrecovery.org
502-614-7473
Web address — http://peopleadvocatingrecovery.org

How the War on Drugs Impacts Mothers with Addiction

Since America’s war on drugs mandatory sentencing law in 1986, incarceration of women has skyrocketed 400% and 800% for African American women. 80% of women in prison have substance abuse problems. 66% of incarcerated women have minor children.

Mothers who seek drug rehab, face a ‘Sophie’s choice’ dilemma with few options for treatment that includes childcare. When a child is removed to foster care, they become unintended victims bouncing from foster home to foster home and may age out as legal orphans. Only 20% of mothers reunify with their children in the foster care system.

In an effort to help mothers the Substance Abuse and Mental Health Administration gave start-up funds for 35 comprehensive family-based residential treatment programs in 1991. Center Point, which is featured in Moms Living Clean, was one of the first programs in the United States to provide gender specific treatment. Today, in 2010, there are less than 100 family-based programs in 36 states.

Drug and alcohol addiction is an international problem leading to dire consequences for individuals, families and society. Global relevance of the issues surrounding mothers who use drugs is evidenced by treatment programs that have sprung up in other countries. For example: The Glasgow Women’s Reproductive Health Service in Scotland was founded by pediatrician, Dr. Mary Hepburn, in 1990. Dr. Hepburn has been an adviser for the World Health Organization and set up a reproductive health service program for disadvantaged women in Moldova. The Sheway Program in Vancouver, British Columbia was established in 1993, and also has extensive support services for mothers with substance use issues.

In 2000, professionals from various clinics and researchers in Italy, Portugal, Spain, France, Germany, Austria and Greece convened in Venice to gather information for a research programme on the Risk Factors in Infancy and Adolescence. It was supported by the European Commission. Outcomes from their research were published in a book Women Drug Abuse in Europe. They found that “…inadequacy of services is definitely a problem which should be investigated in greater depth with prevention in mind.”

Moms Living Clean will continue the international dialogue around issues of mothers with addiction and provide a viable alternative to help mothers worldwide. The women’s personal stories in the film will validate and encourage women to seek recovery, educate social service providers, law enforcement and judges, and promote funding of family-based substance abuse treatment programs.

Moms Living Clean a documentary-in-progress

Sheila Ganz, filmmaker

           Six mothers with addictions on the verge of losing custody of their children enter an innovative substance abuse treatment program in San Rafael, California hoping to turn their lives around.  Filmed over three years the feature documentary Moms Living Clean chronicles the women’s struggles and triumphs through the six month residency and their transition back into the community. 
           Rachel escaped her abusive boyfriend with her two babies and wants to stop the cycle. Lisa S was in prison for selling drugs hopes to start over.  Leslie charged with online prostitution and drug use, works to rebuild her life after losing custody of her daughter.  Lisa R relapsed and is determined to make it this time.  Krista didn’t think she had a problem.  Julia wants her son to be drug-free. 
           Confronting their past is difficult.  Rachel was neglecting her daughter’s needs.  Lisa S vows responsibility for her infant daughter.  Leslie questions why she let men abuse her for money or great make-up sex.  Lisa R was homeless.  Julia realizes how anger had taken over her life.  Krista’s eight-year-old daughter longs for them to be together. 
          The film interweaves drug laws aimed at pregnant and parenting women with addictions, and the legacy of imprisonment and foster care on their children. 
         This blog will keep people updated about our progress to complete the film.   It also serves as a forum for Action Alerts on legislation, policies, events and programs concerning pregnant and parenting women with addictions in the US and around the world.  Your thoughtful comments are welcome.   Thank you.