Alcohol & Drug Use During Pregnancy
Lecture Notes of Terence T. Gorski
March 7, 2002

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Alcohol & Drug Use During Pregnancy
Lecture Notes of Terence T. Gorski
March 7, 2002
(Unproofed Draft - Revised 03-12-02)

1.    Hello.  My name is Terry Gorski.  I'm the president of the CENAPS Corporation, an education, training, and consultation firm specializing in managing problems related to alcohol, drugs and violence.

2.    Today we have gathered together to celebrate the coming births of many new lives into our community.  

A.  There are many joyful and positive things that will be discussed with you today.  As we begin, you may feel that you won't be hearing any of these joyful and positive things from me.  Why?.

B.    Because I've been asked to discuss a subject that many people see as an unpleasant and frightening.  I've been asked to talk about what can happen to unborn children when pregnant women use alcohol and other drugs during their pregnancy.  

C.   Although this topic does contain some some difficult truths, you'' also see that I'm going to discuss many positive and hopeful things.

(1)  Imagine this!  Imagine that I was here to announce a major breakthrough in prenatal care.  

     This breakthrough is a simple procedure that all pregnant women could use. 

     This major breakthrough prevents 

     This breakthrough virtually eliminates many of the problems that cause serious developmental problems that follow children and families for years.  

(2)   Image that thjis breakthrough was able to significantly reduce or eliminate many of the major birth related problems.  

     It could reduce or eliminate miscarriages, still births, and      Sudden Infant Death Syndrome (SIDS).

     It could reduce or eliminate many complication that lead to the deaths of mothers during the birthing process.  

     It could reduce or eliminate birth defects, mental retardation, and many of the problems associated low birth weights

     It could reduce or eliminate mental retardation, many of the learning disabilities, and attention deficit disorder.

     It could siognificantly reduce childhood and adolescent behavior problems including alcohol and drug abuse, child and adolescent conduct disorders, rageful behaviors, violence, and crime.  

(3)  What would you think if I were to announce this type of breakthrough?  You'd probably think that this was pretty good news.  Some of you might even consider it to a positive and hopeful message.

 D.   The fact is, this is exactly the breakthorugh in prenatal care that I'm gping to announce.   And this breakthrough is not knew.  We've known it for decades.  

(1)   Unfortunately we've done a poor job of letting pregnant women and their families know about it.

(2)   We've done even a worse job in helpinbg preganant women and their families to understand how to idetnify and treat a common medical problem that makes it difficult or impossible for some women to implement this simple prenatal recommendation.

E.   This major breakthrough in prenatal care is this:  

(1)   The use of alcohol and other mind altering medications and drugs can seriously harm pregnant women and their unborn children.  This harm can result in the long list of major problems I just listed for you.

(2)   Whenpregnant women learn about this potential damage to themselves and their unborn children, most make a serious decision to stop using alcohol and other drugs.  

(3)  80% of the preganant wpmen who try to stop using alcohol and other drugs during preganancy succeed.  They stop using alcohol, nicotene, and other mind altering drugs.

    The women who are able to stop using alcohol and other mind altering drugs during preganancy are able to prevent almost all of the alcohol and drug-related burth problems and developmental problems that I've just described.

    In other words, alcohol and drug related birth and developmental problems are 100% preventable if women stop using those substance during preganancy.

(4)  If we give preganant women accurate information about the potential effects of using alcohol and other drugs on themselves and  their unborn children, 80% decide and are able to stop using these susbstance.

(5)   Unfortunately, 20% of women who have been armed with accurate information about alcohol and other drugs try to stop using but they can;t stay stopped.

    The good news is that we know why most of them can't stop.

    They can't stop and stay stopped because they're addicted.

E.   Hopefully, several positive things can come out of this discussion.  

(1)   I hope that after  hearing about the damage that can be done, you will decide not to smoke, drink, use mind altering prescription medication, or use recreational drugs during your pregnancy.  

(2)  I also hope that if you're pregnant and can't stop using alcohol or drugs, no matter how hard you try -- that you'll know that you and your unborn baby need help.   

    You'll know that you have a serious disease or illness called addiction.  

    You'll also have hope because you'll know that addiction is treatable.  

    You'll know that there's effective treatment and caring people willing to reach out and help you and your family.

(3)  I'm also hopeful that by the time I'm done talking with you, you'll understand several things:

    First, you'll understand that Addiction is a genetically influenced brain disease.

    Second, you'll know that the disease of addiction causes your brain to respond abnormally to the use of alcohol and other mind altering drugs.

    And third, you'll know that there are three good indications that you have the disease of addiction:  

        First, using alcohol and other drugs will make you feel really good;  

        Second, you'll have a hard time thinking and talking about your alcohol or drug use without becoming angry, defensive, fearful, ashamed or guilty.  And 

        Third, when you try to stop, you'll feel so bad that you can't stay stopped.  You'll start drinking and using mind altering drugs in stpite of your commitment to stop.  You's start drinking and using mind altering drugs again even though you know its harmful to both you and your unborn child.  You won't feel good about it.  You'll feel ashamed and guilty -- but you'll go back to drinking and using prescription or illegal drugs anyway.

    In other words, you'll understand that once a person becomes addicted, she looses the ability to control her  alcohol and drug use.  

    You'll know that addicted women, even if they're pregnant, can't stop and and stay stopped even though they see how harmful alcohol and drugs can be to her, to her unborn baby, and to her family.   

    In short, you'll know that addicted pregnant may be out of control and may need get help from trained addiction professionals.

3.    I want you to leave this presentation with three messages imprinted upon your mind:

A.    The first message is this:  Using alcohol, nicotine, mind altering prescription medications, and recreational drugs are dangerous to both the mother and the unborn child.

B.   The second message is this:  Non-addicted women who love and care about themselves and their unborn child will stop smoking, drinking, using prescription medications and recreational drugs during pregnancy.  

C.  The third message is this:  Women who try to stop and can't are probably addicted and need to seek treatment.  

(1)  They don't need to be labeled, judged and punished.  They need to be educated and helped.

(2)  They don't need to be punished by the courts, they need to be treated by addiction trained health care professionals.

4.    Let's look at some information from our local area <go to the article>.  

A.    Every day in Hillsborough County, an average of 75 women await an opening in a publicly funded substance abuse treatment program.

B.  

C.   These women don;t fit the traditional stereotypes of pregnant women with alcohol or drug problems.  Of the women admitted to treatment in 1995 or 1996:

     59.7 percent were 31 to 45 years old.

    61.6 percent were white (34.9 percent were black, and 7.3 percent were Hispanic) 

    66.4 percent had two or more children.

    67.9 percent were unemployed, but many were stay-at-home moms

5.    That's the bad news.  But here's some good news.  

A.    Addiction is a brain disease that is highly treatable.  People can and do recover with proper addiction specific treatment.  Getting help does work.

B.  Addicted people are sick people who need help and not bad people who need to be good.

C.   Addicted people are sick people who need treatment and not criminals who need to be punished.

D.   The best way to help women stop drinking and drug during pregnancy is to recognize addiction as a disease not a crime or a moral defect.

E.   The most effective way to stop drug use among pregnant women is to educate women, their husbands, and members of the community about three things:

(1)  The dangers of using alcohol and other drugs during pregnancy

(2)   The fact that most women who keep using in spite of know those dangers are addicted and need treatment

(3)  How to get pregnant women into effective addiction treatment without putting them at risk of arrest, imprisonment and loosing their children.

F.    This means training all members of the community, especially doctors, nurses, emergency services professionals, judges, family law attorneys, and child welfare professionals.

G.   The message must be crystal clear:  

(1)   Any pregnant woman who can't or won't stop drinking and drugging is probably sufferring from a brain disease called addiction that destroys her normal values, judgment, and impulse control.   

(2)   Any pregnant woman who can't or won't stop drinking and drugging is probably an addicted person with an serious illness that need treatment.   

H.   The proper first approach to any woman who is using alcohol or other drugs during pregnancy is: 

(1)   To reach with caring and concern.  

(2)  To provide accurate and non-judgmental information, and 

(3)  To provide access to effective addiction treatment without putting them at risk of arrest, imprisonment and loosing their children.  

I.   The threat of harsh punishment does nothing but drive addicted women underground.  

(1)   It keeps them from getting prenatal care and virtually guarantees two things - 

    that most addicted pregnant women will stay addicted throughout their pregnancy; and 

    that they will do serious harm  to  themselves and their unborn children.

6.    Using alcohol or other drugs during pregnancy is dangerous for both the birth mother & her unborn baby.  Using alcohol and other drugs during pregnancy increases the risks of ...   

A.    Placental Abruption caused by the placenta pulling away from the wall of the uterus before labor begins. This condition can lead to ...

(1)   Miscarriage

(2)   Premature labor

(3)  Extensive bleeding during labor and delivery that can be fatal for both the mother and her baby. 

B.   Low birth-weight:  Babies of women who use alcohol and drug use regularly during pregnancy are between three and six times more likely to be born at a low birthweight (less than 5.5 pounds) than babies of women who do not use the drug. 

(1)   Low birthweight can result from poor growth before birth, premature birth, or a combination of both. 

(2)   Low-birthweight babies are 20 times more likely to die in their first month than normal-weight babies. 

(3)   Those who survive are at increased risk of lifelong disabilities including mental retardation, cerebral palsy, visual and hearing impairment.

C.  Impaired Infant Functioning at Birth  

(1)  Lowered sensory-motor responsiveness at birth. 

(2)  Reduced motor ability 

(3)  Slowed reflexes

(4)  Diminished attention span

(5)  Cycles between ...

    Periods of withdrawal &  unresponsiveness

    Extended periods of prolonged deep sleep

    Periods of agitation marked by being  jittery, irritable, restless, and easily startled by the gentlest touch or sound.

    Extended periods uncontrollable crying during which they are very difficult to calm or comfort

(6)  increased difficulty bonding with the mother or primary care giver

    Decreased ability to respond to a human face or voice

    Feeding difficulties including refusal to latch on when mother attempts to nurse and cycles of refusing to eat and gorging

D.    Birth Defects caused by the adverse effects of the drug upon the developing fetus.  

E.    Sudden Infant Death Syndrome (SIDS):  Greater-than-normal chance of dying of sudden infant death syndrome (SIDS). 

F.    Problems in child Development:  alcohol and drug use exposed children are more likely to have ...

(1)  Slowed or impaired emotional and cognitive development

(2)  Delayed development of gross motor skills needed for running, walking, and hand-eye coordination and fine motor skills needed for learning to write, draw, and play musical instruments.

(3)  Slightly lower IQ Scores (about 3 points lower)

(4)  More severe language and learning problems making it more likely that they will need special education to help reach their full potential.

7.    Here's Some More Good News:  The risk of birth defects and other problems caused by alcohol and drug use use during pregnancy can be prevented or minimized by following these guidelines:  

A.   If you don't drink or use drugs, don't start.  

    This will eliminate the possibility of damaging your child by alcohol or drug use during pregnancy.

B.   If you use alcohol or other drugs, stop before you become pregnant.  

    If you are using prescription medications, check with your doctor to assure that they are necessary and safe for your unborn child.

C.   If you can't stop and stay stopped ...

(1)  Delay your pregnancy by using birth control or sexual abstinence until you  have successfully completed substance abuse treatment and are confident you can keep from using alcohol and other drugs.

(2)  Start substance abuse treatment immediately.  If you can't stop using even though you want to it means that you probably have an alcohol and drug problem that will require treatment.  

(3)   Remember ...

    If you keep drinking and using drugs it is unlikely that you will be able to responsibly prevent pregnancy.  

    If you can't stop using alcohol or other drugs before you get pregnant, the odds are that you won't be able to stop after you get pregnant.

    Using alcohol and other drugs during pregnancy can damage your unborn child and cause serious problems at birth that can delay their development and create problems latter in life.  

C.   If you are using alcohol and drug use and discover that you are pregnant ...

 (1)  Stop using the drug immediately.  

    This will reduce the risk of having premature or low-birthweight babies and of damaging your unborn child in other ways.  

(2)   Immediately Start Treatment for Substance Abuse.  

    Without substance abuse treatment the likelihood of returning to substance us either during pregnancy or shortly after the birth of you child is very high.   

(3)   Stay in substance abuse treatment for the duration of your pregnancy and six months to one year after the birth of your child.

8.   Stopping alcohol and drug use during pregnancy is only the first step in protecting your child.  

A.   The regular and heavy use alcohol or other drugs during infancy, childhood, and adolescence will ...

(1)  Prevent you from being an effective parent

(2)  Damage your children. 

(3)  Destroy your marriage and make a healthy relationship with a sober and responsible person impossible

B.    You must be alcohol and drug free in order to provide your children with the quality parenting that they need to avoid future problems.

C.   If you or anyone in your family is abusing or addicted to alcohol or other drugs you increase the likelihood that your children will be at high risk of developing serious problems with ...

(1)  mental and emotional functioning

(2)  behavioral control

(3)   hyperactivity

(4)   learning

(5)   delinquency

(6)   substance abuse 

D.   The easiest part of being a parent is conceiving and delivering the baby.  

E.   The most difficult part of being a parent is becoming the type of person who can teach your child to be a sober and responsible person.  Remember we teach children by both word (telling them) and deed (showing them by doing it yourself).  Out deeds speak more loudly than our words.

9.    Only sober & responsible people are capable of being effective parents.  

10.   Being an effective parent means ...

A.    Being committed to doing whatever it takes to help your children grow into a healthy and responsible adults.  (Being a parent is a challenge -- bring it on!)

B.   Being willing and able to meet the basic physical and emotional needs of your children need at all stages of their development 

C.   Staying alcohol and drug free so you can be a good role model for sobriety and responsibility.

D.   Learning specific parenting skills for ...

(1)   early infancy, 

(2)   the toddle and preschool years, 

(3)   childhood, and adolescence.  

E.   To be a quality parent means that you must develop and use ...

(1)   a parenting plan

(2)  a family management system that meets your needs and needs of all family members

(3)   life planning and  problem solving skills

(4)   emotional management skills

11.   We are all capable of being effective parents.  All it takes is knowledge, hard work, and a dogged persistence to keep learning and growing as people while loving and guiding our children toward the goal of becoming sober and responsible people.  It's hard work, but we can do it!

12.   Thank you for letting me share these ideas with you.

This presentation is meant to provide general information only 
and does not constitute medical advice.

References

Arendt, R., et al. Motor development of cocaine-exposed children at age two years. Pediatrics, volume 103, number 1, January 1999, pages 86-92.

Delaney-Black, V., et al. Prenatal cocaine exposure and child behavior. Pediatrics, volume 102, number 4, October 1998, pages 945-950.

Eyler, F.D., et al. Birth outcome from a prospective, matched study of crack/cocaine use: II. Interactive and dose effects on neurobehavioral assessment. Pediatrics, volume 101, number 2, February 1998, pages 237-241.

Lester, B.M., et al. Cocaine exposure and children: the meaning of subtle effects. Science, volume 282, October 1998, pages 633-634.

Slutsker, L. Risks associated with cocaine use during pregnancy. Obstetrics and Gynecology, volume 79, number 5, May 1992, pages 778-789.

Chavez, G., Mulinare, J., Cordero, J.F. Maternal cocaine use during early pregnancy as a risk factor for congenital urogenital anomalies. Journal of the American Medical Association, volume 262, number 6, 1989, pages 795-798.

Volpe, J.J. Effect of cocaine on the fetus. The New England Journal of Medicine, volume 327, number 6, August 6, 1992, pages 399-407.

This presentation is meant to provide general information only 
and does not constitute medical advice.

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