Heather Sonnenburg, an Oregon mother of three, struggled with substance use disorder (SUD) for about seven years. During one of her three pregnancies, she continued using substances. “[I was] in a situationship with the father of my children, and then also just in the grips of my addiction,” she says. “I kept it very unknown to anybody … and so the loneliness that comes with that, and trying to hide from family, friends, and the medical providers—I know that lonely feeling of isolation and not having support.”
Eventually, Sonnenburg was able to get help and has now been in recovery for nine years. But she says that if she had received judgment-free medical care and support, “I could have gotten that help sooner.” Now, she works as a peer doula for Project Nurture, a program led by nonprofit Health Share of Oregon that helps pregnant people with SUD.
Stigma and fear of legal consequences or losing custody of their children can lead pregnant people with SUD to delay or avoid medical care. The consequences can be serious: A recent study found that drug-related pregnancy-associated deaths (fatal drug overdoses during pregnancy and one year postpartum) in the U.S. increased by nearly 200 percent between 2010 and 2019 and by another 55 percent between 2019 and 2020.
Programs across the country are working to address the stigma by offering judgment-free care, peer support, and other services during pregnancy and after birth. We spoke with people involved in several of these programs about what that support can look like and why it matters.
Offering care without judgment
In North Carolina, Brittany Jones, a birth and postpartum doula who founded Melanated Bellies, helps clients understand their options and advocate for themselves by “Letting them be in the driver’s seat of their care [and] helping them build that voice back.” She adds, “Although yes, you have an addiction, you still have a choice.”
Jones and her team focus on providing empathetic, empowering, compassionate care. “If we stop and just take a moment and come from a place of empathy in working with people, it gets [them] a lot further,” she says.
That support can be especially important for Black mothers, who may face additional stigma and discrimination in health care.
Project Embrace, a New Jersey maternal wraparound program led by The Cooperative, takes a similar approach. Quinn Ingemi, associate director of behavioral health, says even seemingly small interactions can make a difference for people with SUD. “People will tell us how wonderful it was that they went to a provider, and somebody said congratulations about their pregnancy,” she says. “We’ve heard people say to us they’re very surprised when they’re treated well.”
Recovery support specialists and peer support
Recovery support specialists and peers (people who have experienced SUD themselves) play a key role at Project Embrace, helping people connect with resources and navigate the health care system.
For example, Ingemi’s team may help someone apply for social service benefits in person or join a call with a client and another provider to make a “warm handoff” during a crisis. “We are willing, when possible, to be side by side with you because it is daunting for people to enter into care, and we acknowledge that,” she adds.
The program also provides support up to a year postpartum. “[Motherhood] is a tough transition. Whether it’s the first baby or the fifth baby, it’s tough all the time,” Ingemi says. “And so, if you’re also concurrently dealing with a chronic, relapsing disease, which is substance use disorder and addiction, it can be even more challenging.”
Project Embrace also works to ease fears stemming from previous negative health care experiences. Before clients give birth, the program can introduce them to providers and social workers and help them understand what to expect.
Peer support is also central to Oregon’s Project Nurture, as peers can “best understand where they’re coming from [and] the issues that they were facing,” says Dr. Cat Livingston, medical director of Health Share Oregon, which started the program.
“The peers themselves have been instrumental to the development of the program and helping make sure that stigma is eradicated as much as possible,” Livingston says.
Harm reduction: Meeting people where they are
Harm reduction starts with understanding what someone wants and needs, rather than requiring them to be ready for treatment before offering support. For Jones of Melanated Bellies, that means having conversations with clients about their goals and building trust.
“Being able to gain their trust to be able to say, ‘I’m just here to hear you out and help you in whatever goals you are working towards,’” she shares. “And not necessarily forcing treatment or forcing treatment compliance down people’s throats.”
Livingston says, “it’s really important to meet people where they are,” including telling them about available treatments and support while recognizing that “not everybody’s going to be willing to engage in treatment.”
For peer doula Sonnenburg, it ultimately comes down to making people feel safe.
“[Mothers with SUD] are coming in to have their happiest day, they’re not coming in to get judged,” she says. “[So] let’s make it even more safe for them.”
If you’re seeking treatment for SUD, talk to your health care provider or contact SAMHSA’s National Helpline (1-800-662-HELP).
This article was supported by Project Embrace, a maternal health program from The Cooperative, a New Jersey nonprofit. Public Good News retains full editorial control over its reporting.