Waiting Families Education: Adoption and Prenatal Drug Exposure

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The waiting time is a wonderful opportunity to learn more about adoption and some of the issues that may need your attention as your child grows. One of these issues may be related to substance use during pregnancy by your child’s birth mother. We hope you use this as a learning tool to enhance your adoption preparation. Don’t forget, after you have read and reviewed this material, log into the Adoption Portal to complete the summary in the Domestic Education section.

A message from AAI

We keep careful statistics on the reports of substance use during pregnancy by the expectant mothers we work with. We know you’ve already given this topic thought and consideration as part of your home study and profile process. But it is a topic we encourage you to continue studying. 

As you know, one of the factors we consider when choosing adoptive family profiles to show our expectant mothers is her reported substance use in combination with your degree of comfort with substance use. For the second half of 2020 about half of the expectant mothers we worked with reported substance use during pregnancy. We’ve seen a notable increase in the use of opiates. Please take time to really study this issue again. We intend to find a family for every baby that comes into our care, no matter the degree of exposure – you may be that family! Please talk with your caseworker at any time if you’d like to change your substance exposure preferences. You can also check out the resources on our website.

On the surface, it’s hard to imagine why an expectant mother would use substances during pregnancy. But let’s try to understand. Most, if not all, of the women we work with didn’t intend to get pregnant. They may also be struggling with other challenges that contribute to their ultimate decision to make an adoption plan such as mental health concerns, medical problems, or financial struggles such as unemployment, housing instability, or homelessness. They often don’t have positive emotional support in their lives and may even be living in abusive relationships. They might already be involved with child protective services or the criminal justice system.

Here are just a couple of first-hand accounts of women who used substances during pregnancy:


I grew up in a large family with ten brothers and sisters. I am the middle child and was always close to my dad. At 8, I began to suffer from chronic migraines. My dad gave me AC&Cs, which are aspirin, codeine and caffeine. As I got older, I began to experiment with alcohol and other pills. I had been sexually and physically abused at a young age and found the best way to numb that pain was to get high. I had many great goals for my future but as the years went on, I slowly let them go. At 18 I was again in an extremely abusive relationship and believe he would have killed me if I hadn’t eventually moved after three years. I never told anyone of any of the abuse, so I found drugs were my only friend. After a year [in college], I moved back, got into another abusive relationship, and before I knew it, was shooting up heroin and doing meth. The two things I swore I would never do. Over time, I started dealing and trafficking heroin and before I knew it, I was doing 3-4 grams a day and was facing four different felony charges for selling to an undercover. I began going to the methadone clinic and after 28 failed drug tests I stopped using. After years of not using, I had a relapse with meth, got arrested for violating my parole and went through treatment. I got completely off of everything the first time in 20 years and didn’t know how to be clean. I had amazing family support but being the only child with an addiction, I wanted my best friend back — drugs. I ended up getting pregnant and getting back on methadone. I had an amazing baby boy and was so lucky he didn’t have to go through withdrawal from the methadone. 


“Addiction is a family disease… One person may use, but the whole family suffers.”

Let me explain the impact of this quote…my mother used and I almost lost her several times. After unfortunate events in my life, I followed the example of my mother and began using. I did whatever I could get my hands on [drugs], and I often did so with my mother. I hated myself; that hate made me use more. Until the night I overdosed and found myself in the hospital. The nurse informed me I was pregnant; she pointed me in the direction of getting help, but it was up to me. I struggled to get clean and just when I thought I was under control my mother appeared for a visit. I was awful and spiteful to her. She was the reason I was like this, in my mind and she would never be around my child, unless she cleaned up. Long story short we cleaned up together, and it brought us closer together. My mother was with me when I brought my daughter into this world. We promised that she would never see the world of addiction through our eyes. 

This is a burden for us as an adoption agency; if we say adoption is a positive, life-giving alternative to abortion, then we want to be ready to step up and care for the babies who will be born as a result of this choice. We believe that each of these precious little ones deserve the opportunities that come with a loving family, so we’ll keep working hard to find just the right parents for each and every situation we face. You are part of the solution! You’ve already stepped forward and said yes to adopting a child when you may not have a full picture of the background – that takes a leap of faith, and we are grateful for you!

Please check out the following resources to educate yourself more fully on this topic.

Creating A Family, is a website full of radio show recordings, blog posts, and resources. Here are three different resources to check out. Please choose at least one, listen, and then write about your impressions in the education section of your portal. Additionally, check out this infographic about myths of prenatal alcohol and drug exposure.
Finally, read through the following article from Adoptive Families Magazine.

Prenatal Drug Exposure — What Parents Need To Know

Your baby may have experienced prenatal drug exposure. Our adoption medicine expert explains what to watch out for and how to respond.

By Deborah Borchures  

When you adopt — whether a domestic or international placement, independently or through an agency — it’s prudent to be prepared for your child to be at risk for the effects of prenatal substance abuse.

Although this might sound very frightening, research shows, in fact, that almost all children will do well in a loving, stimulating home.

Although medical professionals frequently request testing of a newborn’s urine to determine exposure to drugs, these screens have little predictive value. They reveal exposure to drugs only in the 72 hours before the test and thus give no information about exposure earlier during pregnancy.

Prenatal exposure to drugs, alcohol, or tobacco, may have only mild short-term consequences, but the consequences may also be more long-term. Unfortunately, there is no way to predict with certainty the impact of prenatal substance abuse upon a child at the time of the child’s adoption.

Looking Out for Symptoms

Children exposed to drugs, alcohol, and tobacco prenatally may exhibit a range of symptoms. Prenatal drug and alcohol exposure increases the risk that a child will be born prior to due date and have low birth weight (less than five pounds at full term).

Many newborns exposed to illegal substances experience symptoms of withdrawal, including tremors, irritability, and difficulty sleeping. Sleep problems may include the persistence of frequent nighttime awakenings until four to six months of age.

Feeding difficulties may arise, too. Many children with prenatal drug exposure require a prolonged feeding time and may be easily distracted during feedings. These symptoms may persist through the first year of life yet show no correlation with long-term impairments.

Adoptive and foster parents may also observe small motor coordination and balance problems or delays in language development. Although “typical” children start to discriminate between caregivers and strangers at six to 12 months of age, this too may be delayed.

Larger motor skills, including sitting, crawling, and walking, are not usually affected. Parents whose children exhibit these symptoms should not necessarily assume that the sole cause is prenatal drug exposure, as other factors may play a role.

Longer-term Considerations

Little is documented about the long-term effects of exposure to illegal substances during pregnancy. As children enter school, parents and teachers may observe that earlier delays continue, and parents may seek educational assistance for their child.

Are these children at greater risk for becoming drug abusers themselves? Again, the medical literature does not yet hold the answers. One thing is certain: There is risk of a “self-fulfilling prophecy.”

Parents and professionals should discuss drug abuse with adolescents without suggesting that the child is more likely to abuse drugs because his or her birth parent did so. As an adolescent develops his own identity, such expectations may, in fact, increase his interest in exploring illegal substances rather than curtail the behavior. In open adoptions, adoptive parents will need to promote abstinence but not suggest criticism of the birth parents.

Maximizing Your Child’s Potential

What can parents and professionals do to maximize the potential of children exposed to illegal drugs prior to birth?

  • Remember that not every child will be affected in the same way, and there is no way to predict what a child’s impairments will be.
  • Do not assume that nothing can be done. Research shows that almost all children will do well when placed in loving and stimulating homes. Anticipation of concern will affect how a child will do long-term. Parents who proactively identify their children’s needs early on and get the help they need will find that their children thrive.
  • Children who show developmental delays should be referred for educational interventions through the federal Early Intervention program (for infants through the third birthday) or through local school systems (for children three and older). Programs are often available at little or no cost for children who qualify. Referrals for speech therapy, occupational therapy, or physical therapy may make sense.
  • Mental health professionals can help parents cope with difficult behavior in their children. Specific assistance should be given to help children develop secure attachments with caregivers.
  • Parents of infants with feeding, sleeping, and irritability problems may need support or respite care to prevent burnout.

Although the effects of prenatal drug exposure are different for each child, all children do better when families and professionals work together to meet the challenges.

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