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Pregnancy

Pregnancy is the right time to focus on yourself

In Our Own Voices: Pregnancy

Congratulations on your pregnancy!

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Pregnancy can be a very exciting time. When you find out that another life is growing inside of you, it’s also common to feel overwhelmed, nervous, and maybe a little sad. For some women, pregnancy doesn’t even feel real for the first few months.

Some women are undecided if they want to keep their pregnancy, and some need help figuring out how to make changes in order to prepare for being a mother.  

This website can help with all of that! We made this site just for you: to give you information, support, guidance, and encouragement as you begin your journey of having a baby or becoming a mother in recovery from substance use disorder.  

Whatever you have going on and wherever you are right now, this site is for you.  

A few things to remember

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  • You are not alone  
  • Take it one day at a time  
  • It’s never too late to get started on your recovery  
  • The People to Meet Checklist can help you find a prenatal provider, if you don’t already have one  
Pregnant woman lying on her back in a hospital bed looking at a sonograph image.

Life in the Womb

Click each tab and read along or listen to the audio to learn ways to keep you and your growing baby healthy and strong.  

Shared Blood
Your baby is growing. And the materials that will become your baby’s body come partly from your genes and partly from everything you eat, drink, and smoke while you are pregnant.

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Life in the womb is a time of tremendous growth and change. Your baby gets a safe place to grow in your uterus, and also gets all of the oxygen and nutrients to nourish their growth through your bloodstream! 

Wait, WHAT? My baby lives off of my blood?? 

Well, yeah. There is something growing on the inside of your uterus, along with your baby, called the placenta. It looks like a red balloon, lined with blood vessels. The “string” of the balloon is the umbilical cord, which is attached to what will become your baby’s belly button. Through that cord, your blood with all of its vitamins, fats, nutrients, proteins, oxygen-filled red blood cells, germ-fighting white blood cells, and more, gets passed along to your baby. 

Until your baby is born, they are a part of your body. You share blood. And, since they can’t eat or drink or smoke on their own, they get whatever you give yourself. And whatever you take in, those are the building materials for your baby’s body. 

It sounds confusing, but it’s really pretty simple. A baby’s cells develop partly through the genes of their parents and partly through the nutrients or toxins passed along through your blood. 

That sounds like a giant responsibility and, in some ways, it is. But it’s important to remember in order to grow a healthy and strong baby, it’s good enough to be good enough. 

We will give you some tips, and your prenatal care provider (your doctor or midwife) can offer more ideas of how to take good care of your body and your baby. For now, start where you are. Be as gentle with yourself as possible and take everything one step at a time. 

Your Baby’s Growth
Small changes can make a big difference!  
  • Drink lots of water  
  • Take prenatal vitamins  
  • Get enough sleep  
  • Go for a walk, or get another kind of exercise  
  • Quit smoking, or at least cut down  
  • Talk with your provider about ways to reduce drug or alcohol use safely  
  • Go to your prenatal appointments as these are important, no matter what else is going on!  

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Sometimes we are in a place in our life where changing what we take or eat seems very hard. It’s important not to be too hard on yourself. Remember that any little change you can make, like smoking fewer cigarettes, drinking lots of water, taking prenatal vitamins, or getting a little extra sleep can really pay off! 

Perhaps, without taking on too much at once, think about a little change that feels doable and try it for a week or so. You are stronger and more capable than you think you are. 

Keep in mind that nicotine, alcohol, and other drugs can affect how your baby grows. Smoking tobacco or marijuana during pregnancy reduces how much oxygen your baby gets, which can affect growth. It may also impact whether or not you will be able to breastfeed once your baby’s born. 

If you think your body might be dependent on a substance that you’re taking (for example, if you shake whenever you stop drinking alcohol or go through withdrawal when you don’t take a particular drug), make sure you talk to your provider before you try to quit or cut back. It’s best for you and your baby’s health to make changes slowly and with medical supervision. 

Another thing to keep in mind is that getting good prenatal care matters even more than whether or not you are completely sober. So don’t let fear or shame keep you from getting help. 

Prenatal Visits
Your first step is to find a doctor or midwife you like. This checklist can guide you as you connect with a prenatal care provider and other hospital workers who can help you have a safe delivery and a healthy baby. 

Download People to Meet Checklist 

When you go to your prenatal appointment, take along this Tip Sheet that lists questions you may want to ask. 

Download Prenatal Appointment Tip Sheet 

Download Consent Form 

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Prenatal visits are a great way to track your baby’s growth and to monitor your health and progress. These visits are essential to healthy pregnancy. You might find them reassuring and helpful for building a strong relationship with your doctor or prenatal caregiver. 

Sometimes, however, especially at first, people find these appointments a bit scary. Some women have trouble remembering all of their questions or speaking up for what they need. 

We have created a Tip Sheet that can help you organize your thoughts and get answers to your questions at your visits. There is room at the bottom for you to add any other questions you’d like to ask. We suggest you print the Tip Sheet out and go over it with your provider. 

A Short Forever
While pregnancy is the first step on the Journey of Motherhood, your pregnancy can also be a first step on the lifetime Journey of Recovery. 
It’s a good idea to keep a record of all your appointments and treatment. These records can help you feel prepared for any conversations about custody that come up after your baby’s birth. Take a look at our Birth Planning Checklist for the kinds of information to include in your records. 
To help your providers coordinate your care in and out of the hospital, you must give written consent by signing a release of information form. This allows your providers to speak to one other and share information about your care. 

Download Birth Planning Checklist

Download Consent Form

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Remember, what is now is not forever. Pregnancy and infancy are a small part of the 20 plus years of raising a child. But choices you make now can have long-lasting effects. 

Ask your prenatal care provider to write down the care you get at each appointment so that you can keep a record. Also, share this information with your treatment provider, if you have one, so that all of your providers can work together to make sure you get the medications and care that you need. Even though it’s a good idea to share information, you have the right to consent before your providers speak with one another. We have a sample information release form in the Resources section that explains exactly how to give your providers permission to talk about your care. 

After your baby is born, there are usually discussions about custody, and deciding if you are prepared to begin parenting your baby right away. It can be helpful during this time to have a packet of records that show the efforts you made during your pregnancy to protect your health and the health of your baby. 

Pregnancy can be an exciting, scary, happy time. It’s totally normal to have really big feelings, or to not know how you feel at all. One thing that we have found helpful is to put First Things First. If you are starting recovery, or if you are already in recovery from a substance use disorder, putting that Recovery First — ahead of your family, your friends, your job, anything else — will make everything else possible. 

Pregnant woman in her kitchen, slicing a banana into a blender.

One Step at a Time

What is a small change you can make today?  

You are preparing to be a mother. This is for you, and it’s also for your child. Don’t let fear or shame stand in the way of getting what you need.  

If you need help finding treatment or services, call the Massachusetts Substance Use Helpline at 800-327-5050.  

Pregnant woman in a striped shirt sitting cross-legged on a mat and cradling her abdomen.

It takes a village

Pregnancy is really the first stage of parenting. You’re taking care of your baby already, in how you take care of yourself. What small thing can you do today to take good care of yourself?

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Welcome to pregnancy!

No matter how far along you are, it is always the right time to take good care of yourself and take positive actions toward your well-being and the care of your baby. Remember, this journey is a marathon, not a sprint. You’re building the foundation for a new way of life—and that happens brick-by-brick, step-by-step.

The most important thing to remember is that no one goes on a big journey by themselves.

We will talk about how to assemble a team of people who will help support and guide you along your way.

Pregnant woman smiling and looking down in a sunlit kitchen

Recovery first!

Pregnancy can be a very busy time. You might feel like you have way too much to do. It’s a good idea to put your recovery from substance use at the very top of every to-do list you make.

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Pregnancy can be a very busy time, with doctor’s appointments, preparations to make, and changes to your physical and emotional energy. If you have a substance use disorder, it’s also important that you get what you need to support your recovery.

Focusing on your recovery will help you have a safe and more comfortable pregnancy. It will also help lay the foundation that you will need once you have your child. No matter where you are in your recovery, or where you are in your pregnancy, it’s always the right time to seek support and put yourself and your recovery first!

Building your team

Substance use disorder treatment is an important part of your support team. Without treatment or sobriety in place, it can feel hard to do anything else.

There are other folks who can support you during your pregnancy and childbirth. We have a few suggestions of people you may want to have by your side at this time.

It’s totally okay to ask for lots of help right now. And it’s so important to get the help you need, for you and for your baby.

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It might be helpful to think about pregnancy as a special time, like a vacation from your regular life, where you take extra gentle and courageous care of your body. After all, there’s a baby growing inside of you.

Everything you do for yourself, whether it’s finding a support group or eating healthy meals, you’re also doing that same thing for your baby. The most important thing is to take it one day at a time and remember you don’t have to do it alone!

The first important step is to build a team of supporters to help you along the way. Here are some ideas of people you may want on your team. Consider a substance use disorder treatment provider, a recovery coach, maybe a sponsor, or a spiritual or faith leader who you feel close to; a family member, friend, or relationship partner; your prenatal care providers, maybe a midwife or doula. Who will be on your team?

Meet your birthing team

Your birthing team is there to help you during your pregnancy and birth.

Click each tile below to learn more about these teammates.

OB (Obstetrician) or Midwife
An OBGYN

An Obstetrician or OB is a doctor who specializes in caring for pregnant women. They offer prenatal care and can deliver your baby.

A midwife can also offer prenatal care and delivery services, especially if you don’t have medical complications.

Mother/Baby Nurse
An nurse with a smiling mother and her newborn

The Mother/Baby nursing team helps take care of mom and baby in the hospital.

Neonatologist/Pediatrician
A pediatrician
  • A doctor who cares for newborn babies while in the hospital.
  • They may be called to a delivery if any problems come up.
Doula
A doula consulting an with a pregnant woman who is lying on her back on a hospital bed
  • Is sort of like a counselor just for women who are having a baby
  • Can help with emotional support
  • Can help you think about what you want your childbirth to be like
Lactation Specialist
A mother nursing her newborn with a lactation specialist observing

Someone who helps women breastfeed their baby.

This person can also meet with you during pregnancy to help you learn more about breastfeeding or decide if breastfeeding is right for you.

You can also work with a peer lactation coach, someone who is an experienced mother and can offer breastfeeding tips and support.

Hospital Social Worker
A listening social worker

Clinical social workers are available at most hospitals to talk with you about childbirth and to provide a range of resources, including parenting education, groups for mothers, case management, and access to services both in the hospital and in the community. Anyone can receive a consultation with the hospital social worker. Just ask your OB, midwife, or nurse to connect you.

Meet your recovery team

Your recovery team is a group of people who will support you during and after your pregnancy. Who do you want on your team?

Click each tile below to learn more about these teammates.

Treatment Provider
A treatment provider consulting with a patient
  • Specializes in recovery from substance use disorders
  • Can offer medications that help with cravings and sobriety
  • Can be outpatient, or part of a recovery home, if you need somewhere to stay
A sponsor giving another person a hug.

Someone from a 12-Step program who is also in recovery and can share wisdom and personal experience with you.

Peer Recovery Coach
Two people sitting next to each other on pier watching sailboats.

A special support person who uses their personal recovery experience to guide people through the multiple pathways of treatment and recovery.

Psychiatrist
A psychiatrist

A doctor who can help with medications for your substance use disorder or any mental health conditions.

Make sure they know your substance use history and about your pregnancy so that you get the best advice.

Therapist
A therapist listening to their patient

A really useful support: someone who is just there to listen and support you!

Some therapists specialize in pregnancy-related issues or substance use. Find someone you click with and who understands your situation.

Other Team Players
People holding hands in a circle
  • Faith-based counselor
  • Peer mom in recovery
  • Pregnancy coach
  • Supportive family and friends
  • Who else will be on your team?
A pregnant woman in a hospital gown sitting on a hospital bed cradling her abdomen.

Making the Most of your Prenatal Visits

Click on each tab to reveal tips on how to make the most of prenatal visits.

Tours

Visit the hospital and meet with people important to your delivery and your baby’s first weeks of life. Use the People to Meet with During Pregnancy checklist, and then have a hospital social worker help you make appointments. Bring a member of your team with you for support.

This checklist can also help you find a prenatal care doctor or birthing hospital, if you don’t already have one.

Download the People to Meet With Checklist

 

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To help you prepare for delivery, go on a tour and go to a consultation (or meeting) at the hospital or birthing center of your choice. Talk to other women and people you trust and ask about different options for delivery. Decide which place you want to use, perhaps because they allow women to room-in with their babies after delivery, or because there’s a particular doctor or midwife that you prefer. It’s your choice where you deliver.

Once you pick a hospital or birthing center, ask for a tour of the delivery floor and the nursery, or where the baby might stay. Meet with a pain specialist, a lactation coach who can tell you about your options for breastfeeding, the people who take care of new babies, and the other folks who will work with you during delivery and your baby’s first few weeks of life. Take a look at our list, People to Meet with During Pregnancy. A hospital social worker can often help you make all of these appointments. When you attend these meetings or go on a tour, think about bringing someone from your team along—it can be very helpful to have a buddy close by!

Questions to ask

Prenatal appointments are your chance to check on your health and your baby’s. Take this Prenatal Appointment Tip Sheet to all of your visits. Your provider can help you understand everything that is happening and answer all of your questions.

Download Prenatal Questions Tip Sheet

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Your pregnancy, along with early recovery if you are in treatment, can feel like a string of endless meetings and appointments. It’s common to feel tired of going to all of these appointments and repeating the same information over and over. Keep this in mind, though: your prenatal and recovery appointments are small steps toward becoming a sober mom. They are little acts of love, for you and for your baby.

We have made a Tip Sheet to help you make the most of your prenatal care visits. We encourage you to print out the Tip Sheet, write down any other questions you have, and bring it to your appointment.

Your providers can help you understand everything and answer all of your questions. Your body is strong and smart; you can understand what’s going on with your body, and you have a right to that information.

Pregnancy and medications

Babies do best when mom feels well. Go over all your medications and supplements with your prenatal provider, and make sure your prescribing doctors know you are pregnant.

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If you’re taking any medications or supplements, finding out that you’re pregnant can raise a lot of questions. It is important to tell your prescribing doctors right away that you’re pregnant and have an honest conversation about the risks and benefits of all of your medications. Some medications pose no risks to pregnancy, some can be unsafe, and some are worth taking even if they pose some risk because of how important they are to your health and well-being.

The most important thing to remember is that your health—your physical, mental, emotional well-being—is critical to the growth and development of your baby. Babies do best when mom feels well. If you are honest with your doctor, you can work together to decide which medications are safe to continue taking and which ones you might want to switch or slowly stop using. You are the expert on your body and mind; doctors can help provide the information you need to make the right choices for you.

Bias and support

Take a support person with you to your appointments, and make sure you find a provider who you like and trust. Be as honest as you can with your provider, and bring the Prenatal Appointment Tip Sheet along to help.

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For some women, the scariest part of the prenatal visit is telling their provider about their substance use disorder. Some women have a hard time remembering all of the questions they want to ask. Still other women worry if their provider understands their situation well enough to give good advice. Here are some helpful tips:

  • You can bring a support person to your appointments. Perhaps a partner, family member, sponsor, friend, or recovery coach can come along and take notes, encourage you, or just sit and provide moral support.
  • Doctors might need education from you! Not all medical providers have the same expertise or experience. You may want to ask your doctor if they understand addiction and how it can affect pregnancy. If you feel uncomfortable with the knowledge or attitudes of your provider, try and find a different one that you feel more comfortable with!
  • In addition to education, some providers still carry biases about addiction or recovery: attitudes that might limit their ability to be helpful to you. It’s important to stay positive and not fight with any provider. If you feel able to have an open conversation with your provider, you might change their attitude, which could help many women who will come after you. If, however, their behavior makes it unsafe or uncomfortable for you to stay in their care, request a different provider.
A doctor holding a stethoscope on a pregnant woman's stomach while she reclines on a hospital bed.

Dealing with Fear and Loss of Control

You can be a courageous advocate.

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Here’s a reminder: everything you’ve read and heard here are suggestions. You are the expert of your body and ultimately you will choose what’s right for you.

For women who have experienced tough stuff, or who have felt powerless, it can be hard to be honest with providers and share information. It’s totally normal and reasonable to want to keep control of your privacy and make decisions on your own.

It’s possible, though, that the professionals have tips or information that will help you in your journey. Talk with someone you trust about your fears of sharing information. Make sure you have a provider who you trust and who is knowledgeable about both pregnancy and addiction.

And remember that you can be a courageous advocate for your own needs and preferences. If you need help advocating for yourself, call on one of your team members. These are important skills that will come in handy when you are a mom, advocating for the needs of your child.

If you don’t think your provider understands addiction, tell them what it means for you, or ask to be referred to someone who does. You deserve the best care for you and your baby.

A pregnant woman silhouetted against a lake in sunset, looking down

Emotions

Strong emotions are common during pregnancy, but that doesn’t mean they should be ignored. Tell someone you trust right away if you are feeling more sad, afraid, or angry than usual or if you are having trouble sleeping or eating. You can call this free, private hotline at any time for emotional support and resources:

1-800-944-4773

If you feel unsafe for any reason, you can also go to your local emergency room.

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You may have heard of postpartum depression, or sometimes it’s just called postpartum. That makes it sound like depression, or sadness, that happens after the baby is born. In fact, it doesn’t always look like that. We now know about something called perinatal emotional complications. Let’s break that down: “Perinatal” means any point during your pregnancy and up to one year after delivery. “Emotional complications” can mean any number of things that women feel at this time: sadness, anxiety, trouble sleeping, worried thoughts, irritability, and more.

And here’s the biggest news: perinatal emotional complications are totally normal! About 70% of women tell their doctor about some emotional challenges during pregnancy and early parenting.

And it’s easy to see why! During pregnancy your hormones change rapidly as your body adjusts and grows a baby. You are also preparing for a major life event, which might disrupt or change your living situation, relationships, financial plans, sleep patterns, and more! In your body, mind, and environment, everything is in flux. Add to that the stressors, changes, and feelings that come with early recovery, and you are likely to have strong and maybe painful feelings while you’re pregnant. Remember, this is totally normal; talk about what you’re feeling with your team members and your providers.

Strong emotions can trigger urges to relapse into old, unhealthy behaviors, so it’s especially important to tell support people who can help you treat this normal condition quickly. Pregnancy is a huge deal, and early recovery is not always comfortable. But that doesn’t mean you have to suffer. If you have any unusual mood swings or feelings, talk about them with your team, midwife, doctor, and treatment providers. Keep advocating for yourself, even if you have to educate people who don’t understand perinatal emotional complications.

Tons of women experience this, so you’ll be helping the other women who will see that provider in the future. It’s not only good care: it’s prevention!

A doctor holding a prescription bottle while talking with a pregnant woman

Pregnancy and Medication-Assisted Treatments (MAT)

Check out the information revealed under each tab to learn more about using MAT during pregnancy.

MAT is OK

Using medications such as methadone or buprenorphine to assist in your recovery is safe during pregnancy! In fact, it may be the safest choice for you, especially if it helps you stay engaged with treatment. Make sure your providers know what substances you are taking, how much you take, and for how long you have been taking them, as well as any other symptoms to make sure you get the right medications for your recovery.

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A special note to women who are interested in medication-assisted treatments, such as methadone, suboxone, or buprenorphine (also called MAT):

It is okay to use medications such as these while you are pregnant. In fact, if you will have a hard time staying engaged in treatment without MAT, it is the safest thing for you to stay on or get on MAT while pregnant. This way, your baby won’t be at risk if you go into withdrawal, and won’t be exposed to other infections, such as HIV or hepatitis, which might occur if you use needles. Methadone clinics all over the state have experience working with pregnant women and some buprenorphine providers know how to work with pregnant women, too. Make sure you have a provider that is knowledgeable and understanding.

If you need to get on MAT and are currently using, a detox or hospital stay might be helpful to stabilize. Other women prefer to go to an outpatient clinic and get stabilized on MAT at home. You can talk to an MAT provider to figure out what option is best for you. Make sure the provider knows exactly what substances you are taking, how much you take, how often, and how long you have been taking them.

Metabolism and MAT During Pregnancy

“Metabolism” is how your body makes new cells or produces waste by processing what you eat, drink, or take. During pregnancy, your metabolism speeds up.

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As your baby grows, your metabolism increases so that it can process food not only for your body, but also for your baby. As your metabolism speeds up, you will also process the MAT dose more quickly. This is why pregnant women often need to gradually increase their MAT dose as their pregnancy progresses. Make sure you tell your MAT provider about any symptoms or discomfort, as this might indicate the need for a dose adjustment.

 

Will my baby experience withdrawal?

Neonatal abstinence syndrome (NAS) happens when a baby is born and cut off from any drugs or medications that it was exposed to during pregnancy. The size of a woman’s MAT dose does not affect the chance that her baby will show symptoms of NAS. Reducing cigarette smoking does help reduce NAS symptoms for many babies. Every baby is different, but for all babies, NAS is temporary and you can help treat it.

Download NAS Guide

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Research has shown that a high or low dose of MAT does not change the chances that a baby will show signs of withdrawal after birth. So don’t worry if your dose increases.

Limiting habits, such as cigarette smoking, can lower the chances that your baby will experience withdrawal. If you do smoke, even just cutting down can make a big difference.

We will talk more about infant withdrawal, or neonatal abstinence syndrome (NAS), on the next step in our journey. For now, it’s enough to know that MAT is often the best choice for a pregnant woman’s sobriety.

What should my doctor know?

Most providers understand the importance of MAT. Make sure your prenatal care provider knows about your MAT dose. Sign a release so that they can talk to your MAT prescriber. This is very important for when you are ready to deliver and you need to get the correct dose while you’re in the hospital. It’s also important so that your doctor can plan for your pain management during and after labor and delivery.

Click the link below to download a release form that you can print and take to your providers.

Download Consent Form

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Women on MAT give birth every day, and there are plenty of ways to help them with the pain of childbirth.

Talk to your provider about your options for childbirth and pain management, and ask to see an anesthesiologist (or pain specialist) at the hospital to get all of your questions answered.

What happens after childbirth?

You may need to adjust your MAT dose after you give birth. Make a plan with your prescriber before delivery so that you get your needs met.

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After delivery, your metabolism will begin to slow down back to its normal rate (or processing speed). This might mean you’ll start to feel sleepy if you don’t begin adjusting your MAT dose with your provider. Many women want to feel alert after birth so that they can spend time with their baby, and they need to make sure their prescribers adjust their dose so that they don’t feel too sleepy. Talk with your MAT provider before delivery so that they can give the right instructions to the hospital.

You are a priority

Pregnant women have priority access to substance use disorder treatment in Massachusetts. If you don’t have a medication-assisted treatment provider, and you would like to get one, call the  Massachusetts Substance Use Helpline at 800-327-5050.

You’ve finished this milestone

You got this!

These are the resources mentioned in this module: