Reaching Pregnant People with Addictions

Coaches help pregnant people with addictions navigate all aspects of life, from doctor visits to finding housing.

“Look at that little bald head,” Jewel Adams said.

Moving toward Adams in the arms of her mother, and wearing a ruffled, magenta onesie, is 3-week-old Safiyah James.

“Hi Sophia,” Adams said.

“It’s Sah-fiyah,” said Kia Nassik, 27, as she allows Adams to hold her daughter in her apartment just south of Madison, Wisconsin. Safiyah sticks out her lower lip, squints her eyes and lets out a small cry.

“She saying, ‘these ain’t my mama’s hands.’ I know, I know,” Adams said, rocking Safiyah for a few moments before handing her back to her mother.

Though this is Nassik’s second child—she has a 5-year-old daughter as well—she feels like a first-time mom. During her first pregnancy, she tells Adams, Nassik was in the midst of a seven-year addiction to crack cocaine and heroin. This time, she’s celebrating two recovery milestones: one year since using crack, and two years since using heroin.

Adams, a mother and grandmother, with baby Safiyah. Building consistent relationships throughout the pregnancy makes a huge difference in recovery, she says. Photo by Jessica Martinaitis.

“I look everything up online,” she told Adams. “When I first got home, [I Googled] how to hold a newborn the correct way.”

Adams is a coach for Pregnancy2Recovery, a program that connects pregnant women struggling with substance use disorder with recovery coaches. Having fought through their own experiences of addiction during pregnancy, the coaches give hope and resources to other pregnant people. Nassik, a coachee, was one of them. 

Even though she is not now working with Pregnancy2Recovery, the program made a difference during Nassik’s pregnancy. “I struggled quite a bit during my pregnancy,” Nassik revealed in a hushed voice. “For some reason I was craving crack,” Nassik said. “It’s not even my drug of choice, but I’ve never been addicted to something that’s so mental.” 

Like Nassik, people all over the country are making tough decisions about themselves and their children in an often hostile system where honesty can bring shame and fear: When mothers are afraid to be honest with their doctors, they may hide that they’re struggling with addiction or skip doctor’s visits altogether. This is particularly a crisis in Wisconsin: It’s the Midwestern state with the highest number of children born experiencing drug withdrawal, and the state’s “Cocaine Mom Law” puts women at risk of prosecution, forced medical care, and losing custody of their children.

In Jan. 2020, legislation passed in the Wisconsin House of Representatives that makes it easier for the state to terminate a substance user’s parental rights. Under the new statute, if a baby is found to have drugs in their system at birth, parental rights can be immediately terminated unless the mother enrolls in a treatment program within 90 days. 

“[These women] don’t trust the system,” said Dr. Kathy Hartke, an obstetrician-gynecologist who has been practicing in Wisconsin for more than 30 years. “They hear about [the Cocaine Mom Law] from other sources, from friends, and they don’t come for prenatal care because they think their babies will be taken away if they come during their pregnancy.”

Studies show that the fear of being reported to Child Protective Services deters women who use alcohol and/or drugs from seeking out or following through with prenatal care. It’s a problem that only becomes worse when legislation defines using drugs or alcohol during pregnancy as child abuse/neglect.

Better outcomes

“When I found out I was pregnant, I wasn’t ready by any means,” said Tanya Kraege, one of Pregnancy2Recovery’s developers. “It was an unplanned pregnancy, and I was using drugs.”

Still, Kraege wanted to do right by her child. For eight months, she abstained from drugs and alcohol. Then, Kraege’s doctor said she could have a glass of wine. It helps with the stress of the third trimester, he told her. 

Kraege relapsed that night and used cocaine for two days. “I thought that my child was going to be enough for me to not use, and that wasn’t the case,” she said.

Left to right, Adams and Tanya Kraege have a meeting at Kraege’s home ins Madison, Wisconsin. Both women are mothers who used drugs during their own pregnancies and are in recovery. Photo by Jessica Martinaitis.

Fearing the impact on her baby, she told her doctor. “I felt really ashamed,” Kraege recalled. “He was so good to me. He didn’t make me feel guilty or judged. He took the time to help me.” 

Kraege’s doctor recommended she go to intensive outpatient treatment. Following his direction, she remained sober for the rest of her pregnancy. But many women don’t have that experience. Faced with the possibility of prison time or losing their child if they’re honest with their doctors, many stay silent.

In Wisconsin, the number of babies born whose mother used opioids or another addictive substance during pregnancy tripled from just over 300 in 2009 to over 1,000 in 2014, according to the Wisconsin Department of Public Health. Studies have shown that pregnant women with substance use disorder are some of the most vulnerable in our society, often having a history of trauma, child abuse, domestic violence, mental health disorders, and houselessness. 

Those addicted to substances often feel judged by their medical providers, Kraege explained, and often lack the resources to get help.

This need lead Kraege and her co-developer Skye Boughman to create a program based on personal relationships with someone who understands the guilt, shame, and stigma of having a child while in the grips of addiction. In addition to being trained as advocates, the recovery coaches—who are required to be sober for at least one year—are in long-term recovery themselves. 

Since Pregnancy2Recovery’s inception in 2017, 36 women have been referred to the program, 31 have met with coaches and 14 are either graduated or currently enrolled. The program is open to all pregnant people, regardless of gender identity, and has been expanded to work with fathers and facilitate anti-stigma training for medical professionals. 

While the field is new, early research shows that recovery coach programs for pregnant women lead to better outcomes for both mother and child, because they take a trauma-informed, holistic approach. 

This distinction often makes all the difference in whether a woman stays in addiction treatment. One study showed that women in pregnancy-specific treatment programs were less likely to drop out than those in traditional programs, particularly if the program addresses other trouble areas, such as prenatal care, finding a job or home, therapy, and nutrition. 

Recovery coach programs are particularly promising because the intersecting identity as mother and person in recovery gives the coach credibility and compassion, while also allowing them to provide valuable insight. Studies show that a family-focused approach leads to better health outcomes for both the mother and her child, significantly reducing the risk of substance abuse exposure at birth.

Coaching looks different for everyone. For Adams, who’s been a coach since the beginning of the program, it means getting up early before work to take the bus each day one hour downtown to visit coachees in drug court or the county jail. She also works another job and is a mom and grandmother.  

Jewel Adams returns home after a missed meeting with a client. Adams sometimes calls clients for weeks before they follow through with meeting her. Photo by Jessica Martinaitis.

Other coaches attend doctor appointments with their clients, get them into treatment programs or help them apply for resources such as food assistance. Most importantly, the coaches act as advocates, helping their coachees learn to navigate doctors’ offices, drug court, looking for housing, and learning to be a parent—things that can be challenging for any person in recovery, but all the more overwhelming when pregnant. 

Still, while there’s great interest in expanding the program in other locations and states, the thing that makes it so effective—the personal and nuanced nature of the care—makes it hard to replicate. 

“People using substances, they don’t trust people,” said Kraege, adding that it can take more than six weeks for a coach to build rapport with their coachee. “[Adams] does so much more than coaching … handing out brochures and meeting people on the bus and just really wanting to help. She’s really able to have [empathy] on a deep level because of her own experiences.”

Back at Nassik’s house, two women, united in a shared story, are celebrating. “Kia, you can beat [the cravings],” Adams said. “I just made 15 years [sober]. I’m not saying that it’s going to stop because it’ll never stop. It’ll never stop it, but it’ll get better.”

“That’s a big deal,” Kia said as the two embrace. “I can’t wait to be able to say that.”

This story is a part of a larger documentary project that will be screened at the AmDocs Film Festival in March, 2020. It has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems, and by the Social Justice News Nexus at Northwestern University’s Medill School of Journalism, Media, Integrated Marketing Communications.


Jessica Martinaitis is a multimedia journalist and documentary filmmaker based in Chicago. She has spent the past year covering social issues in Chicago and Wisconsin criminal justice, school discipline reform, women’s rights and the opioid epidemic. She is committed to producing work that stimulates policy change and meaningful shifts in social equality. Before transitioning to journalism, Jessica worked as an art director and creative producer of web design and multimedia content for businesses, art galleries, nonprofits and activists in New York City and Prague, Czech Republic. Jessica holds a master’s degree from Northwestern University’s Medill School of Journalism, where she specialized in Social Justice and Investigative Reporting.
Mary Hall is a digital journalist who uses her experience in multimedia, research, and project management to creatively and authentically tell social justice stories. She has a wide range of experiences, from founding a profitable magazine to implementing social video strategy to working as a researcher on investigative projects with some of Chicago’s biggest publications. She has reported from Ecuador, Cambodia, Cuba, and all over the U.S., and is a three-time award-winner from the Illinois Press Association for infographics. She believes that stories are best told by people who have the lived experience and seeks to form deep relationships with her subjects.

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