Empowering Mothers One Day at a Time: A Focus on Rehabilitation Approaches Concerning New Mothers with Trauma or Addiction Issues

Imagine you are walking down the street and you see a visibly pregnant lady smoking. What would your initial reaction be? Anger? Disgust? Pity? Would you go up to her and tell her this is not okay? Or would you simply ignore it and not look back twice; knowing you have the moral superiority never to see and be in that position yourself? I wanted to raise that matter to address a systemic issue in the way we perceive “bad mothers” the problem being it more so than ever seems like an actively vindictive choice to have to be neglectful and absent not to consider your children to fulfil your own worldly desires when it is seemingly just expected from the men.

From a psychological perspective, these forms of biases, especially considering treatment for patients in rehab can be detrimental at times. This alienation and dehumanisation of mothers can have a genuine impact on the path to recovery for patients and their offspring as well. There is a reason most of the recorded history looking into parental trauma only considers fathers since it is the socially expected norm for men to be absent most of the time and so much of the emotional and physical labour comes to bear on the mother, something that they usually never get credit for. 

When we talk about mothers and how rehab should be adapted towards them, the first thing we need to consider is if addiction is premeditated or is a coping mechanism to mitigate symptoms of postpartum depression. 

Commonly referred to as ‘baby blues’ Postpartum depression can manifest anywhere from the day of delivery to 6 weeks later, longer if left untreated.

At least 40% of women do not seek postpartum care, according to the American College of Obstetricians and Gynecology. This tendency is influenced by several factors, including racial disparities, inadequate anticipatory counsel, low socioeconomic position, lack of insurance, inadequate family support, inadequate home visitation, and poor transitional care management.

During the first week of the postnatal period, severe hypertension, severe bleeding, and infection are the most common contributors to maternal deaths, while cardiovascular cause is the leading cause of late deaths. Compared to developed countries such as Norway and New Zealand, India has significantly lagged in providing adequate prenatal care. The current infant mortality rate for India in 2024 is 25.799 deaths per 1000 live births which is higher than the other countries. and India has a significantly lower number of maternal healthcare providers, such as obstetricians and midwives. Earlier postpartum visits need to be mandatory to evaluate for resolution of postpartum blues and other chronic medical conditions such as hypertension and diabetes and to improve both maternal and neonatal mortality and morbidity.

Approaches to addressing rehabilitation facilities regarding mothers with substance use disorders can vary on the inpatient. Pregnant women should undergo detox from alcohol and drugs for safety and child health. Treatment methods depend on the substance, abuse level, and the mother's health. Addiction to alcohol and sedatives should be treated in an inpatient setting with 24-hour medical care.

Alternative drugs, such as methadone, may be utilised during detox in some cases, such as opioid addiction. Methadone use can improve results for moms and their babies when accompanied by comprehensive care and prenatal care. Nevertheless, treatment for withdrawal symptoms may still be necessary for neonates exposed to methadone. According to certain research, buprenorphine replacement therapy—also offered as Suboxone, a combination medicine that includes naloxone—may cause less severe acute withdrawal symptoms in infants than methadone.

Alcohol detoxification may involve prescribed medications, but caution is advised due to potential fetal/neonatal risks. Other medications like disulfiram, naltrexone, acamprosate, topiramate, baclofen, and ondansetron may be used. During detox, recovery resources may be incorporated to help pregnant women live drug-free lives. While detox and medical stabilisation are critical, they do not constitute drug addiction treatment on their own. Detox should be followed by comprehensive therapy to address the causes that led to substance abuse.

A qualitative research conducted by Chou, J.L et al. also emphasised the effectiveness of the children being involved in the rehab care as it can be healing for them and the mothers’ successful completion of family-centred residential substance use treatment. The mothers highlighted concerns around services that did not support their children. One inpatient said, ‘[Treatment] drew us closer, and if I hadn’t had them with me, I probably wouldn’t have stayed. I probably would have rather been in a car, but have my kids with me, because I couldn’t—I would always be afraid that somebody is mistreating them or something, or they’re not getting fed, or where are they sleeping?’

It is obvious that family therapists need to take into account the obstacles that mothers face while seeking treatment, as well as the need to receive therapies that take into account the contextual elements that are particular to mothers—particularly those that include these women's children. In fact, the body of research on mothers and drug use clearly shows that access to quality childcare is a major obstacle to mothers seeking treatment (Werner et al., 2007). According to the women in this study, being away from their kids would discourage them from seeking therapy and they were worried about their kids' safety. 

If women's children could not attend treatment, they were unlikely to initiate and participate in it. While there are undoubtedly certain circumstances where mothers can receive adequate treatment, most programs include restrictions on the number and/or age of children who can accompany their mothers to treatment. Moreover, family-centred services like childcare (19%), transportation support (45%), housing assistance (40%), or domestic violence and employment counselling (44%) are offered by less than half of women-only treatment programs (Olmstead & Sindelar, 2004). Mothers frequently have to make the tough choice to forgo therapy during a potentially timely chance for intervention due to a lack of comprehensive, mother-friendly treatment resources (Hanson et al., 2015). When these obstacles are addressed, as they were for the mothers in this study, women can continue to be parents while also on the road to recovery.

References:

Chou, J. L., Cooper-Sadlo, S., Diamond, R. M., Muruthi, B. A., & Beeler-Stinn, S. (2019, October 16). An exploration of mothers’ successful completion of family-centered residential substance use treatment. Family process. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160039/ 

Lopez-Gonzalez, D. M. (2022, December 11). Postpartum care of the new mother. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK565875/ 

Lander, L., Howsare, J., & Byrne, M. (2013, July 16). The impact of Substance Use Disorders on families and children: From theory to practice. Social work in public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725219/ 

Berlin, L. J., Shanahan, M., & Appleyard Carmody, K. (2013, December 9). Promoting supportive parenting in new mothers with substance-use problems: A pilot randomised trial of residential treatment plus an attachment-based parenting program. Infant mental health journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4461036/ 

         Sharp, A., (2024,August 16). Drug & Alcohol Rehab Centers for Pregnant Women

         https://americanaddictioncenters.org/rehab-guide/pregnant-women

About the author:

Nausheen is a reader, eater, outfit repeater, overzealous tweeter and explorer of esoteric rabbit holes. She loves film, and photography and enjoys wearing Crocs during all seasons. A romanticist whose favourite movie is In the Mood for Love by Wong Kar Wai, Nausheen describes herself as Tony Soprano if he had a little Carrie Bradshaw about him. This geek also wants to be a future clinical psychologist and author someday.