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No easy answers to FASD

Posted: September 9, 2011 - 10:25am

Today is International Fetal Alcohol Spectrum Disorders (FASD) Day. All around the world, people are recognizing the 9th day of the 9th month, representing the 9 months of pregnancy when women should not drink alcohol. Here in Alaska, FASD is a big issue. Here on the Kenai Peninsula, it’s a big issue. We have a great diagnostic team, and we do some wonderful education. Statewide, we are a leader in this area. But we still have a lot to work on, and one of those areas is our perceptions of why women drink during pregnancy. If we are going to help families impacted by this disability, we would do well to broaden our understanding of the complexities behind it. It is good for us to step back and remove judgment. We might begin by de-stigmatizing pregnant women who abuse substances. We might train medical providers and social workers in trauma-informed care.

Most of all we need to set aside blame and begin to provide relationship-based help that takes into account the complex lives of women who drink during pregnancy.

Does this make something rise up in you that says, “No! Lock them up, or just tell them to quit drinking and screwing up their children!”? Once again, let me urge you to step back for a moment.

Many women have compelling stories to tell of how they came to grips with their addictions, and how difficult it was to face the fact that their actions caused damage to their children. When I ask women if they drank during pregnancy and the answer is ‘no’, even in the face of evidence to the contrary, I give them time. And mercy.  If I can put myself in the shoes of a woman who is scared because she has had her children removed from her, cannot stay sober, has a faulty support system that either wants to keep her drinking or wants to judge her (or both) it feels like the world is crashing in. And for them, it probably is.

Birth moms tend to fear for their children’s futures, feel they lack proper knowledge about FASD, don’t know who to trust in the medical world, and feel abandoned – which spurs them to try to fix things themselves (often with poor results.)  The factors that go into to alcohol misuse by pregnant women are complex and our responses to their needs must reflect this. The needs of pregnant women who struggle with problems of substance abuse can’t solely be met by any single service or program. Perhaps the most valuable thing we can offer is a supportive and non-judgmental environment.

In light of the complexity of this issue, perhaps we can begin to design prevention, intervention, and treatment for women that takes into account their “lived experience.” Whatever form these things take, they must include relationship-based interventions, treatment programs that give them access to their children, are not punitive, are trauma-informed, and provided by well-trained providers who understand women and addiction. For women who have had their children removed, it is no doubt a vulnerable time, and fraught with opportunities for relapse. Part of the diagnostic process, and part of a woman’s treatment, should involve grief counseling. While removing children may be appropriate and necessary, it’s still another trauma experienced, and the realization that her children are going through FASD diagnosis (quite possibly with some official-types and angry family members involved), is yet another experience of shame and trauma.

It’s an odd mix of messages to want women to take responsibility and not drink during pregnancy, but then to not point the finger when they do. It’s just that shame and blame don’t get anyone sober, nor do they help anyone be a better parent. We live in a culture that deals with problems by punitive measures. That’s how we parent. That’s how we enforce laws. That’s how we do school.

Perhaps we do so because addressing the root issues is too overwhelming. It’s costly, time-consuming, unwieldy, and takes a great deal of energy. And, we really don’t want to go there.

So, I don’t know what the practical solution is. I do know that educated, caring people are trying to break the problem down into manageable pieces.  And, in my role as an FASD educator, parent advocate, and clinic coordinator, I have to do the same thing. One mother at a time. One child at a time. One healthcare provider at a time. One citizen at a time. One bureaucrat at a time. One day at a time.

Vickie Tinker is coordinator for the Fetal Alcohol Spectrum Disorders Program at Frontier Community Services.

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