The 3 Undeniable Truths about Consuming Alcohol during Pregnancy. Prevention and Management of FASD

 

Why do we need to give up Alcohol during Pregnancy?
Alcohol during Pregnancy
It is a known fact that people who crave alcohol struggle with the decision between a bottle of wine and a glass of water. Now imagine the person being pregnant and going through that struggle. If you are one of those people who are sitting on the fence about Alcohol during pregnancy, this article is for you. Most people are aware that alcohol use during pregnancy could have devastating consequences for fetal growth and development.

Preventing Fetal Alcohol Spectrum Disorder

What is FASD? What are its Symptoms?

 

Hales and Lauzon describe Fetal Alcohol Spectrum Disorder (FASD) as a fully preventable cluster of physical and mental defects linked to prenatal maternal alcohol exposure manifesting in children as:
  • Atypical facial features
  • Smaller head size
  • Tremors and poor-muscle tone
  • Difficulty sleeping
  • Sluggish motor development
  • Short stature
  • Delayed speech
  • Hyperactivity
We all know the dangers of drinking alcohol during pregnancy.  What many don’t realize is that the effects of even one glass of wine or one alcoholic beverage could leave children with a lifetime of mental and physical problems. It could result in:
  • Permanent damage to the brain and central nervous system of the fetus
  • Developmental delay
  • Intellectual impairment
  • Behavioral disorder
  • Learning disabilities
  • Attention deficit disorder (ADD)
Despite the above-known facts, FASD seems to be very prevalent among the population all over North America. This article is written to gain insight into FASD. It is based on qualitative research I conducted at Brock University while doing my Bachelor’s (B.Ed.) in Aboriginal Adult Education. It all started when I realized that there are few studies examining FASD prevalence among pregnant women. Any evidence about FASD is obscured due to women shying away from reporting any alcohol use during their pregnancies. Cultural insensitivity towards pregnant women addicted to alcohol makes the women turn away from “medicalized” programs. I have known women who would view even harm reduction programs suspiciously. My inquiries into this matter led me to examine:
  • The causes behind drinking among pregnant women
  • The reasons for their not seeking help or treatment
  • The prevalent social and medical views
  • And the information available for pregnant women
This research in turn, offers:
  • A spiritual perspective, especially from Indigenous cultures, as the first step in working toward prevention of FASD,
  • It offers some tools and practices from the Indigenous tradition and culture, gleaned from accounts and experiences of people dealing with Fetal Alcohol spectrum disorder,
  • It discusses how women and families can use these tools and practices through the various stages, from preconception to postpartum,
  • and offers hope to families for the years after the birth of a child.
My conclusions led to the fact that the approaches to FASD utilized by Indigenous cultures have proven effective when used in conjunction with mainstream harm reduction approaches. These approaches can be mirrored by any culture in the world, which has its roots grounded in spirituality and regard for human values.

Prevalence of FASD: 

Alcohol during Pregnancy - Blog
Prenatal alcohol exposure can only be diagnosed when there is a known amount of alcohol consumed while the mother is pregnant, but this is rarely reported.  Pacey from the National Collaborating Centre for Aboriginal Health states that many true cases of FASD may have gone undiagnosed due to a lack of reporting among pregnant women. Stout, Kipling, and Stout contend that though FAS is prevalent, there is widespread recognition that it represents a serious health threat. And awareness of the danger is the first step towards recovery.

How does society treat women who drink alcohol during Pregnancy?

 

Alcohol during Pregnancy - Blog
Women who drink alcohol during pregnancy are usually bombarded with punitive messages. Maguire explains that living in a collective society does not make it easy for women to speak about their actions or seek help for fear of being judged. Moreover, medical approaches to FASD rely on statistical evidence, a presumption of the cause, therefore holding the woman solely responsible for the condition. Schellenberg highlights that all is not as it seems and points out that social, environmental, historical, or economic factors that need to be addressed are not considered in the case of these women. To make matters worse, research by medical people in the past has been culturally insensitive. As a result, the women do not feel supported, and hence, it has been treated with suspicion by those communities who are affected.

 

Causes of drinking while being Pregnant:

 

Alcohol during Pregnancy - Blog
Tait, Gladstone, and colleagues outline the following as probable causes:
  • Unplanned and unprotected sexual activity
  • Chronic binge drinking
  • addiction and peer pressure
  • depression
  • physical and sexual abuse
  • colonization and residential school legacy
  • past issues of abuse and dysfunction in families

 

Historic causes of Alcoholism in North America:

 

Alcohol during Pregnancy - Blog
Caroline Tait, from the Aboriginal Mental Health Research Team, quotes some early research pointing to “biological make-up and cultural permissiveness to alcohol.”  According to Tait, this begs the question of  which “culture” is being implied here. Culture, true to its roots, has little to do with the creation of alcoholism, which has its roots in colonial oppression and socio-economic marginalization. Especially in Indigenous communities, the rich and deeply spiritual culture that values all life as being sacred surely cannot be equated with being “culturally permissive” to the abuse of alcohol.

Reasons for not giving up alcohol during pregnancy:

 

85% of women in Tait’s study reported continuing substance abuse even after they knew they were pregnant. The Best Start Resource Centre manual, “Supporting the Sacred Journey: from Preconception to Parenting for First Nations Families in Ontario,” states that some women who prefer an abortion may abuse alcohol, thinking that it will cause them to lose the baby. There could be several reasons behind this. They might have had unplanned, unprotected sex, were unaware of the pregnancy, and once it was revealed, are concerned to continue the pregnancy to its full term. Or it could be that they may know people who drank during pregnancy and had babies who they thought were unaffected. The manual also states that some women may not be able to give up alcohol on their own.
Alcohol during Pregnancy
Another reason for women not giving up alcohol during pregnancy is that they are misinformed about what amount of alcohol results in FASD. This could lead to women not taking their drinking, especially binge drinking, seriously. Tait explains that chronic binge drinking rather “extends the period of alcohol toxicity” and hence causes more damage to the fetus. Surprisingly, none of the women in Tait’s study reported seeing a public health poster or pamphlet that gave information on binge drinking and pregnancy. This clearly shows the need to educate women and families about the dangers of consuming alcohol during pregnancy.

Reasons for not seeking help or treatment:

 

Tait brings forward a study conducted by Astley and colleagues, which lists the four most common reasons for women not seeking help. They are as follows:
  1. Not wanting to give up alcohol
  2. Fear that their children might be taken away from them
  3. No one to take care of their children while they go for treatment
  4. Partners not supporting their decision for treatmentAlcohol during Pregnancy - Blog

 

The available information and social views about alcohol during pregnancy:

 

People who appear to lack control over their drinking or use of drugs often face negative moral evaluations and are stigmatized. This assessment is amplified when the behavior is also illegal. According to the CAMH Ad Hoc Harm Reduction Committee, stigma is one of the major challenges in applying a public health approach to alcohol and drug problems. Many times, the information pamphlets on what to avoid before you get pregnant do not take into account the stigma around drinking and the cultural sensitivity or the history of the Indigenous people, in the presentation of the facts. Kim Anderson from the Ontario Federation of Indian Friendship Centers, in her “Mother’s choice” article, talks about a mother who was sexually abused as a child. The mother states that people judge her as to how she could drink if she really loved her child. She says it goes way back before the pregnancy, back into childhood when she was abused.

Alternative perspectives: 

 

Best Start suggests that a harm reduction model may be helpful for people unable to quit. The Harm reduction Model, according to the Center for Addiction and Mental health (CAMH), focuses on reducing drug [or alcohol]-related harm without requiring the complete cessation or stopping of drug [or alcohol] use.” Harm reduction programs in indigenous communities, may not be a long-lasting solution without an understanding of the three critical truths about Alcohol during pregnancy:
  1. Why do we need to give up alcohol during pregnancy?
  2. Why do we need to protect and preserve our future generations from harm?
  3. What are indigenous approaches in preventing or dealing with FASD?
Let us explore the answers, not only from the point of view of prevention of Fetal Alcohol spectrum disorder in infants but from the point of view of healing the psyche and hearts of the communities traumatized by intergenerational trauma.

Indigenous approaches to preventing FASD

 

1. Why do we need to give up alcohol during pregnancy?

 

History of Colonization: 

Alcohol during Pregnancy - Blog
Peter Schmalz, in his book “The Ojibwa of Southern Ontario,” reminds us that the Colonizers introduced alcohol to native tribes to gain more advantage in their intended business. Bartering alcohol for the fur of animals and other treasures (like land) is an example.
Alcohol during Pregnancy - Blog
Understanding “WHO is it that introduced alcohol into their communities?” in the first place, and WHY? would perhaps help us to take a step back to recognize that the cycle of oppression continues to find its mark, sometimes the victims being innocent children. It could help them recognize the first truth of the devastating effects of alcoholism that has gripped their communities and their children. The answers to these questions are evident; we only have to observe history that it was the colonizers who introduced alcohol in North America. Why? To use alcohol as a means to achieve their purpose of grabbing the land that rightfully belonged to the Indigenous communities.

2.Why do we need to protect and preserve our future generations from harm?

 

Boyd and Marcellus in their book “With Child” think that it is impossible to expect that harm-reduction programs alone could counter all the causes which lead to FASD. They suggest that instead of apprehending the child and sending the mother back on the streets, drug [or alcohol] monitoring and supervision along with nurturing “relationships” combined with harm reduction techniques may be the answer to the current problem of substance use during pregnancy. These relationships could be developed with providers and counselors educated in harm reduction techniques. Indigenous thought goes one step ahead.

Community help and support:

 

Alcohol during Pregnancy - Blog
In her article “It takes a Community” Anderson offers the following thoughts:
  • The help and support necessary for parents of children with FASD need to be family sensitive and culturally sensitive,
  • Assuming responsibility for all our children,
  • and the thought that all children ‘belong’ to us as sacred beings…,” helps extended families to take over the care of a child without the child having to go into the hands of Children’s Aid.
Alcohol during Pregnancy - Blog
This is exactly what Cree Elder Maria Linklater, who has fostered hundreds of children, did. Many of these were children with FASD. She is a living example of showing how children can thrive in a caring, structured environment “…loaded with culture and lots of love.” This is the second truth: children can thrive in an atmosphere of love and care from the community.

3. How can spiritual values and traditions help?

 

Sweats: 

 

Alcohol during Pregnancy - Blog
A sweat lodge is a dome-shaped hut built with sticks, leaves and other natural materials for the purpose of cleansing and prayers. Heated rocks are kept in the middle where water is sprinkled, producing steam. The participants pray in a circle and believe that the sweating will offer them physical, emotional, mental, and spiritual cleansing. Doing sweats in an Indigenous sweat lodge with prayers and support of the community is a sacred activity that complements the Alcoholics Anonymous program.  This has helped native men, women, and children in getting over the effects of alcohol. Example: Anderson introduces us to Annette Cutknife, a mother of a child who has FASD. Cutknife relates an incredible story of how she finally got over her addiction. She speaks of her experience of participating in the sweat lodge for three days in a row. She attests that after the sweats, she could feel the aftertaste of beer coming out of her mouth. She describes it as a powerful experience that “sucked the alcoholic spirit” right out of her.
Alcohol during Pregnancy - Blog
Children with FASD need to address the abuse that they suffered in the womb, Anderson says. Hence, doing the sweats in a sweat lodge facilitates healing from anger and provides a calm and peaceful place where one is supported by prayers and well wishes of one’s community. Anderson reports that,
  • Sweats (under supervision),
  • natural diet,
  • native herbs to replace Ritalin,
  • lots of discipline,
  • and a spiritual foundation,
are some of the tools that Maria Linklater uses in her fostering.

 

Connection with animals: 

 

Alcohol during Pregnancy - Blog
Community support worker Jason Louie, as reported by Anderson and Wemigwan, has found that petting furs of different animals has a calming effect on his young students who have FASD.

Right attitudes through spiritual beliefs: 

 

The Indigenous spiritual view develops the attitudes of the society by helping to respect children with FASD the way they are. Anderson introduces us to Youth worker John Barnes, who muses that “a part of the Children who have FASD, is not here in this world. It is with the Creator,” he says. And Jason Louie talks of the use of prayer to gain spiritual strength.
Cultural awareness camps: 
Learning cultural tools to help little children with FASD will bring hope to new mothers that their children can also be helped. Anderson states that traditional native “cultural awareness camps” designed specifically for children who have FASD can bring awareness to pregnant women as to how children with FASD could be helped. These visits could motivate women to go in for treatment and teach them that there are ways of dealing with FASD.

Support from partners in avoiding alcohol during pregnancy:

 

Alcohol during Pregnancy
Tom Porter, a Mohawk Elder, comments that according to Mohawk and Iroquois tradition when a woman is pregnant, the man is also pregnant (Anderson, K., 2000). This belief discourages men from drinking so that the woman may not be tempted to join in the drinking and that she would also get support from her partner in refusing alcohol at public gatherings.
Alcohol during Pregnancy
Anderson explains that it also brings to attention the responsibility that the father and the community have in raising a child.

Drumming and music:

 

During Anderson and Wemigwan’s explorations, Jason Louie observed that the sound of the drum and native music “has a physical effect, stimulating the sense of balance and acting as a regulator for the brain.” To Louie, “every aspect of the drum” is made from nature and has a “healing effect.”
Alcohol during Pregnancy
Anderson also states that Rebecca Martell, a foster mother of a child with FASD, witnessed how Sylvia Wilson from the University of Alberta used the drum to calm down children with FASD; to Martell, it is a “call to the heartbeat of the mother.” This knowledge can be utilized even during pregnancy when the mother can listen to or participate in drumming to help the baby in the womb, and after birth. “Instead of reaching for a bottle, there are other options” is the message being given loud and clear by the Indigenous elders, if only one would allow themselves to open their hearts to their teachings.

Nature, talking circles, and storytelling:

 

Alcohol during Pregnancy
While being ostracized in a collective society is a well-known fear, communities can be transformed by creating safe spaces to talk. Being out in nature, and participating in talking circles and storytelling, which are part of the Indigenous culture are also tools which are seen as being successful in helping children with FASD, and their mothers. Practices such as “talking circles” could help raise awareness about FASD, in the community. Relating his experiences Francis Perry, a Mi’kmaq man living with FASD, comments about his experience with the Canada World Youth program.
Alcohol during Pregnancy
He reminisces about smudging, participating in sweats, going to pow-wows, and talking circles – Francis expresses that this was the first time he sat with a group of people and the first time he had ever spoken and cried in front of people as he felt totally safe. (Anderson, 2002). In her article “It Takes a Community,” Anderson states that encouraging such talk could also help remove the stigma and create empathy, thereby supporting women and helping raise their self-esteem. Acknowledging what happened to the indigenous community in the past and having a strong connection to community and spiritual beliefs constitute the third critical truth needed for healing.

Recommendations from Humsa Prenatals:

 

  • Funded by the Government of Ontario, the Best Start Resource Centre could keep publishing Best Start manuals. Manuals with a culturally sensitive view that is focused on FASD could show pregnant women, from preconception to postpartum, the tools they could employ from their traditions, which could help deal with FASD in their lives and the lives of their children and families.
  • Women who want to get rid of their addiction before getting pregnant could start by doing sweats regularly while being enrolled in programs such as Alcoholics Anonymous.
  • Pregnant women who do not wish to alcohol could enroll in harm reduction programs, get active support from a culturally sensitive community, and adopt cultural, spiritual, and traditional practices to achieve stability and balance in their lives.
Alcohol during Pregnancy
  • Leadership is needed to offer direction to youth and adults to plan pregnancies wisely, and the early introduction of Indigenous principles and history in health education in high schools can be used as a preventive measure.

Conclusion

 

Anderson talks about Della Maguire, who facilitates workshops on FASD, using the four quadrants of a medicine wheel representing the physical, mental, emotional, and spiritual aspects to demonstrate to the participants the need to develop holistically. Medicine wheel of well being
According to Maguire, people whose children are affected by FASD “do not want their child to be labeled but instead want to know what helps.” Indigenous Culture works on the basic principles of the seven grandfather teachings of love, respect, humility, bravery, wisdom, honesty, and truth. Through the above qualitative research’s findings, we can say that a return to their own culture, tradition, and community might just be the answer for pregnant women and families whose lives have been touched by Fetal Alcohol Spectrum disorder. We all have our shortcomings and strengths and helping each other overcome those shortcomings by highlighting and working with the strengths is something we all need a helping hand with from time to time.

Thank you!

 

View this article as a presentation: 

   
Q.M. Sami Childbirth Educator Humsa Prenatals
 Disclaimer:
This qualitative research is based on the writings from various Indigenous and non-indigenous scholars and researchers such as Kim Anderson, Tait, Pacey, Wemigwan, Boyd, Marcellus, Stout, Kipling, Hales & Lauzon etc. and organizations such as Centre for Addiction and Mental Health (CAMH) and Best Start.
The images used in this article are from different communities around the world, and do not refer to any specific community or people. The photos have been used to merely illustrate the ideas of the scholars, researchers and organizations mentioned in the article. References and photo credits Main reference – Kim Anderson 

Resources:

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