THUNDER BAY - Pregnant women and mothers who are substance involved deserve just as much, if not more, compassion from health care providers and should be treated just like every other woman, say bioethics researchers.
Jasmine Cotnam, a research coordinator and liaison Women’s College Research Institute and Canadian Aboriginal AIDS Network, said women seeking care who are substance involved require support and connection to eliminate stigmas.
“One of the quotes that was super important to me was one woman said: you know how hard it is to walk through the door for the first time when you’re asking for help, the last thing you need to have is somebody judging you,” she said.
Lakehead University’s Centre for Health Care Ethics hosted a panel discussion Wednesday and Thursday on about the findings of a local study on the ethics of care with mothers who are substance involved.
Kristen Jones-Bonofiglio, director of Lakehead University’s Centre for Health Care Ethics and a faculty member in the School of Nursing, said the Mother’s Voice Thunder Bay Project was a collaborative effort between the Thunder Bay Drug Strategy, Lakehead University, the Thunder Bay Regional Health Sciences Centre and more than a dozen other community organizations.
The study involved interviewing mothers with substance involvement about their interactions with health care providers.
“The important piece of this project is to get their perspectives to help inform decision making in the city moving forward for that particular population,” Jones-Bonofiglio said. “It can be difficult to serve to meet their needs and we do see some poor health outcomes for mother’s and children.”
The women who participated in the study focussed on four major discussion points, including how health care providers approach patients and the relationship between them, support networks and relationships individual moms may have, and structural barriers, such as housing or transportation.
Substance involvement included anything from alcohol to opioids and any other illicit or legal substances. Jones-Bonofiglio said there were often cases of poly-substance abuse among the participants.
Jones-Bonofiglio said all organizations need to be on the same page in terms of offering a harm-reduction approach, having a trauma informed perspective, and be strength-based.
“Not just looking at that mom with substance involvement as an addiction issue, it’s about that person and it’s also about the strengths that she has, that she has come to that organization in the first place because she wants to help herself and she wants to be the best mom possible,” she said.
Women did share positive stories about relationships with health care providers during the study, particularly midwives who provided continual care and listened to the women’s stories.
This is something all health care providers should endeavour to do, Jones-Bonofiglio said.
“There are a lot of stories of difficult interactions, so stigma, judgement, being told what to do, really being treated disrespectfully,” she said. “It’s important for us to hear those stories as well. They are very honest and I think they can help us as health care providers to help us understand that even if we are not approaching someone with that intention, they can perceive that.”
That kind of stigma can often prevent pregnant women from seeking care because of a fear that Child Protection Services may become involved at an early stage.
There are often cycles of trauma and addiction, Jones-Bonofiglio said, with those women possibly having been involved with Child Protection Services as children, which has created a lasting fear and mistrust.
Substance abuse during pregnancy can have dangerous and long-term effects on the health of the child and the mother and Jones-Bonofiglio said health care professionals must provide that care; it’s just a matter of doing so in the right way.
“From a harm reduction approach, you need to meet that woman where she is at and help her in that moment,” she said. “She may be ready for an approach of abstinence, or she may not. Even if she isn’t there is still a number of interventions and even if it is just connecting with that person for when they are ready to make change, whatever change looks like for them, you’ve established that relationship so people feel comfortable coming back.”
“It’s to support women who are substance involved or could be using substances or have problematic substance use,” Cotnam added. “When they are coming in to access services, whether it’s prenatal care or care for themselves or their children, is to treat them with dignity and respect and to not assume they have made an entirely bad choice in their life or that they don’t want help.”
