Commentary Maternity and Birthing

My Story of Pregnancy and Addiction

Kari Ann Rinker

I am a recovering addict and alcoholic. My journey includes a pregnancy in the midst of my addiction, and unnecessary shame and a lack of compassion at my OB-GYN's office.

Lately there have been several stories in the media about women losing their civil and constitutional rights while pregnant. I’m not referring to abortion, which is often in the news thanks to unrelenting anti-choice attacks and unnecessary regulations. In this case, I’m talking about coverage of arrests, incarcerations, and detentions of pregnant women in the name of “fetal rights”—cases in which women who want to carry their pregnancies to term are accused of providing (or potentially providing) an unsafe or toxic environment to their fetuses. Some of the cases involve women who have admitted to using illegal substances prior to their pregnancy or to their knowledge of the pregnancy.

As a woman and a feminist, my belief about my personal autonomy in medical decision making applies to my right to keep or end my pregnancy. Part of that right includes making my own health decisions during that pregnancy: what to eat, whether to exercise and take prenatal vitamins, whether to smoke, drink, or do drugs. I believe these decisions must be mine to make in consultation with my doctor.

To my knowledge there are no cases of diabetics being detained by authorities for eating a candy bar; cancer patients are not shackled if they light up a cigarette and inhale. So why are pregnant women who use drugs or have a history of drug use being arrested and forced into treatment? It comes as a result of gross overreaching by those in authority—a breach of trust in our medical relationships and false, ideologically motivated interpretations of a plethora of anti-choice laws that have served as vehicles for the deterioration of women’s civil rights.

I am a recovering addict and alcoholic. My journey includes a pregnancy in the midst of my addiction; as was the case with many aspects of my life during my active addiction, my pregnancy was unplanned. As I hear these stories of other pregnant women, I cannot help but identify with them.

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I hate to feed into the anti-choice perception that all pregnant women are vulnerable and afraid, but I will admit that I did feel very vulnerable and very afraid in my pregnancy. That fear was fed heartily by my addiction. I had never really considered having a child. The pill had enabled me to avoid an unexpected pregnancy since I started having sex in my teens, but at 26 my addictions and my irresponsible, reckless, impulsive behaviors were catching up with me. When you’re fortunate if you remember to eat one meal a day, it’s also easy to forget to renew your birth control prescription. That was just another detail among the many in life that seemingly had ceased to have consequences or meaning.

I had gotten pregnant by my boyfriend of two years and he wanted to see the pregnancy through, though I was much less certain. Before I really had time to process these life-changing events, he was proudly spreading the news to friends and neighbors. I was the pregnant girlfriend by his side, feeling as if I was living the whole thing out in some kind of coma and unable to communicate my most primal fear about the pregnancy to anyone: I was terrified of its implications on my drug and alcohol dependency.

Mind-altering, soul-altering, confidence-boosting, medicating substances had been a part of my life since age 14. I felt addicted to everything I ever tried since the first time I tried it. These things made me feel better than I ever felt without them. After all those years, the thought of removing them from my daily routine was unfathomable.

I put one foot in front of the other and did what I was expected to do as a pregnant person, lacking the enthusiasm expected by society and everyone around me. This included my first prenatal visit. In spite of my lack of confidence in my sobriety, I shared my drug history with the doctor, including the fact that the pregnancy was conceived in the midst of heavy methamphetamine use.

As I talked, I felt hopeful for the first time in my pregnancy experience. I thought this medical professional would provide me with reassurance, help me survive my pregnancy, and assist me in staying sober. But my faith in the integrity of the physician soon shattered. As I continued with the details of my drug and alcohol use, her demeanor turned from trusted professional to judgmental, angry authority figure. She stopped focusing on her clipboard, and her tone became harsh as she peppered me with questions about my drug use.

When it was time for my pelvic exam, as I lay on my back with my feet propped in stirrups, the doctor informed me that my fetus would be “destroyed” if I continued to use cocaine or meth. She said my fetus would suffer unimaginably and that I would be to blame.

Kansas is one of five states that requires physicians to inform pregnant women of the negative effects of drug use. But while the doctor was fulfilling her obligation, she could have done so in a kind and rational way. Instead, she chose to make me feel like a criminal.

After the examination, I was sent to the bathroom to take a drug urinalysis. It felt like an intimidation device: I had already been honest about my use of drugs, so why was a test required?

Every time I had encountered a drug test in my life, bad consequences were the result. I was on probation for a time, and it was extended because of a dirty test. I didn’t get jobs because of dirty tests. And I knew this test would come back positive as well. What would happen? Would they arrest me? Would they take my baby away from me once she was born?

These are the questions that keep women from seeking care when punitive testing becomes common. As a Guttmacher Institute analysis from 2000 notes:

Women who fear that they will be taken into custody, lose their children or face criminal sanctions if their drug use is detected, the argument goes, will avoid seeking critical prenatal care and drug treatment services they need for a healthy pregnancy. For this reason, leading medical and public health groups—such as the American Academy of Pediatrics, the American Medical Association, the American Public Health Association and the March of Dimes—all oppose punitive responses to prenatal drug use.

I reiterated to the doctor that I would not produce a clean specimen. She gave me no further information and sent me to the restroom with a collection cup. I finished the test and left the office, even more uncertain and afraid than when I had entered it.

I knew I couldn’t face that doctor ever again.

As it turns out, Kansas does not require drug testing of pregnant women. (A 2008 bill to require the practice was defeated in committee.) And according to that same 2000 Guttmacher report, it was true at the time that “Kansas health care providers may, upon consent, refer a woman at risk for prenatal substance abuse to the local health department for service coordination.” No such offer was made to me.

No doubt this story has played out in similar fashion in doctors’ offices around the country, with scores of pregnant, addicted women, having untold avoidable consequences. Shamed for their lack of self-control, not offered the help, compassion, and resources they need to address their addictions, women leave with their heads hung low, vowing never to return, resulting in greater risk to the health of the fetus and greater harm to the woman’s mental, physical, and emotional well-being.

It is an unnecessary travesty, a shameful way to treat the women who “pro-life” advocates wish to keep in their pregnant condition. Therein lies the pervasive, ever-evolving saga of right-wing societal hypocrisy: policies that mandate drug testing of welfare recipients, state legislatures that refuse to expand Medicaid, cuts to food stamp benefits, lack of affordable and accessible drug and alcohol treatment options, and policies that throw pregnant women in jail or treatment, detaining them against their will. These are the policies that directly and negatively affect pregnancy outcomes and contribute great harm to the pregnancies and the incubators that the right wing loves to love—or, more aptly, loves to control.

I consider myself lucky. I shared my negative experience with a friend who referred me to another doctor. I gave the honesty approach another try and shared my story with the new physician. The doctor’s reaction was one of compassionate understanding, lacking in the judgment and hatred that had greeted me prior. He did not make any effort to rehabilitate me; perhaps he intuitively knew that I would not be receptive to it. He treated me as he would any other patient. I took my prenatal vitamins and made all of my appointments.

Should that doctor have provided me with information about seeking help for my addictions? With my assurances that I wouldn’t use during my pregnancy, I was in denial, and any inference on his part that I might struggle with abstinence and go back to using drugs or alcohol would likely have sent me flying for the door. Avoidance is an art form for addicts. In Alcoholics Anonymous, where I would ultimately gain my sobriety, there is a phrase: “I got sick and tired of being sick and tired.” I had not yet reached that place in my life. While I grappled with staying clean for the sake of the pregnancy, the pregnancy itself wasn’t enough of a motivation for me to give in, let go, and trust in the process of recovery. I was not ready. I had not hit my personal bottom.

I continued to be gripped by my disease—addiction—throughout my pregnancy. I never maintained any significant length of sobriety from alcohol; I did somehow manage to refrain from drug use, though not without great discomfort. I have memories that I will carry with me forever of trying to suck in and disguise my pregnant stomach when entering liquor stores, only to return home to drink alone and cry by myself, talking to the baby inside of me, apologizing for my shortcomings, followed by the great relief of giving birth to a healthy child carried the full nine months. They are the same memories that helped me achieve my sobriety during my daughter’s fourth year of life, a sobriety that has now lasted over a decade.

My daughter, now 15, is my pride and joy. I wouldn’t change my journey for anything. Sobriety happened in its due time. I’m lucky that it happened at all. There are many women who never experience relief from their disease, who will never live up to their full potential, make amends, move on, and feel gratitude for a life lived, a demon conquered, and a daughter to love so deeply.

The details of every woman’s circumstances and every pregnancy are not universal. Whether addicted or not, every woman’s personal story evolves uniquely. However, there are some universal truths about pregnancy: Every woman deserves a doctor who will view her needs and decision making through the lens of her personal history and circumstances, and always, always she deserves abiding and unconditional respect, trust, and compassion, regardless of her background. Women who are low-income, women without health insurance, women who are on public assistance or who are addicted will not benefit from harsh judgment and arbitrary punishment, but they will benefit from education, assistance, and compassion.

Rather than punishing and demoralizing a woman who faces pregnancy under less than ideal circumstances and without a strong support system, more should be done to provide her with empathy and the care that is right for her in her time of need.

Roundups Politics

Campaign Week in Review: ‘If You Don’t Vote … You Are Trifling’

Ally Boguhn

The chair of the Democratic National Convention (DNC) this week blasted those who sit out on Election Day, and mothers who lost children to gun violence were given a platform at the party's convention.

The chair of the Democratic National Convention (DNC) this week blasted those who sit out on Election Day, and mothers who lost children to gun violence were given a platform at the party’s convention.

DNC Chair Marcia Fudge: “If You Don’t Vote, You Are Ungrateful, You Are Lazy, and You Are Trifling”

The chair of the 2016 Democratic National Convention, Rep. Marcia Fudge (D-OH), criticized those who choose to sit out the election while speaking on the final day of the convention.

“If you want a decent education for your children, you had better vote,” Fudge told the party’s women’s caucus, which had convened to discuss what is at stake for women and reproductive health and rights this election season.

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“If you want to make sure that hungry children are fed, you had better vote,” said Fudge. “If you want to be sure that all the women who survive solely on Social Security will not go into poverty immediately, you had better vote.”

“And if you don’t vote, let me tell you something, there is no excuse for you. If you don’t vote, you don’t count,” she said.

“So as I leave, I’m just going to say this to you. You tell them I said it, and I’m not hesitant about it. If you don’t vote, you are ungrateful, you are lazy, and you are trifling.”

The congresswoman’s website notes that she represents a state where some legislators have “attempted to suppress voting by certain populations” by pushing voting restrictions that “hit vulnerable communities the hardest.”

Ohio has recently made headlines for enacting changes that would make it harder to vote, including rolling back the state’s early voting period and purging its voter rolls of those who have not voted for six years.

Fudge, however, has worked to expand access to voting by co-sponsoring the federal Voting Rights Amendment Act, which would restore the protections of the Voting Rights Act that were stripped by the Supreme Court in Shelby County v. Holder.

“Mothers of the Movement” Take the National Spotlight

In July 2015, the Waller County Sheriff’s Office released a statement that 28-year-old Sandra Bland had been found dead in her jail cell that morning due to “what appears to be self-asphyxiation.” Though police attempted to paint the death a suicide, Bland’s family has denied that she would have ended her own life given that she had just secured a new job and had not displayed any suicidal tendencies.

Bland’s death sparked national outcry from activists who demanded an investigation, and inspired the hashtag #SayHerName to draw attention to the deaths of Black women who died at the hands of police.

Tuesday night at the DNC, Bland’s mother, Geneva Reed-Veal, and a group of other Black women who have lost children to gun violence, in police custody, or at the hands of police—the “Mothers of the Movement”—told the country why the deaths of their children should matter to voters. They offered their support to Democratic nominee Hillary Clinton during a speech at the convention.

“One year ago yesterday, I lived the worst nightmare anyone could imagine. I watched as my daughter was lowered into the ground in a coffin,” said Geneva Reed-Veal.

“Six other women have died in custody that same month: Kindra Chapman, Alexis McGovern, Sarah Lee Circle Bear, Raynette Turner, Ralkina Jones, and Joyce Curnell. So many of our children are gone, but they are not forgotten,” she continued. 

“You don’t stop being a mom when your child dies,” said Lucia McBath, the mother of Jordan Davis. “His life ended the day that he was shot and killed for playing loud music. But my job as his mother didn’t.” 

McBath said that though she had lost her son, she continued to work to protect his legacy. “We’re going to keep telling our children’s stories and we’re urging you to say their names,” she said. “And we’re also going to keep using our voices and our votes to support leaders, like Hillary Clinton, who will help us protect one another so that this club of heartbroken mothers stops growing.” 

Sybrina Fulton, the mother of Trayvon Martin, called herself “an unwilling participant in this movement,” noting that she “would not have signed up for this, [nor would] any other mother that’s standing here with me today.” 

“But I am here today for my son, Trayvon Martin, who is in heaven, and … his brother, Jahvaris Fulton, who is still here on Earth,” Fulton said. “I did not want this spotlight. But I will do everything I can to focus some of this light on the pain of a path out of the darkness.”

What Else We’re Reading

Renee Bracey Sherman explained in Glamour why Democratic vice presidential nominee Tim Kaine’s position on abortion scares her.

NARAL’s Ilyse Hogue told Cosmopolitan why she shared her abortion story on stage at the DNC.

Lilly Workneh, the Huffington Post’s Black Voices senior editor, explained how the DNC was “powered by a bevy of remarkable black women.”

Rebecca Traister wrote about how Clinton’s historic nomination puts the Democratic nominee “one step closer to making the impossible possible.”

Rewire attended a Democrats for Life of America event while in Philadelphia for the convention and fact-checked the group’s executive director.

A woman may have finally clinched the nomination for a major political party, but Judith Warner in Politico Magazine took on whether the “glass ceiling” has really been cracked for women in politics.

With Clinton’s nomination, “Dozens of other women across the country, in interviews at their offices or alongside their children, also said they felt on the cusp of a major, collective step forward,” reported Jodi Kantor for the New York Times.

According to Philly.com, Philadelphia’s Maternity Care Coalition staffed “eight curtained breast-feeding stalls on site [at the DNC], complete with comfy chairs, side tables, and electrical outlets.” Republicans reportedly offered similar accommodations at their convention the week before.

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.