So, a little more research and, apparently, for most of us, news about meth use during pregnancy.

According to the Substance Abuse and Mental Health Services Administration,

That last is what I want to concentrate on. The first question — the substance abuse pattern — is one I hope to address in a later post, but for now I'll simply point out that one of the major problems with *any* understanding of how most illegal drugs affect pregnancy is that, because they're illegal, it's very hard to distinguish between the effects of the drug itself and the effects of any other substances or additives that may have been used in producing or cutting the drug — e.g., antifreeze used in making meth, or quinine used to cut heroin. Moreover, since many (if not most) addicts use more than one drug (including smoking) or get their drugs from different sources, the problem of tracing specific effects to specific drugs only gets more difficult. And finally, the observed effects of drug use during pregnancy — it's important that they're observed, rather than known, since you can't always know the cause of what you see — are surely, in many cases, affected by other factors like the mother's health or nutrition or her local environment: stress, environmental pollutants, and lots of unknown factors mean that non-drug users also have babies with some of these problems.

That said, the apparent risks of meth use while pregnancy — which depend on how often and how much is used, as well as at what stage of pregnancy, mind, so keep in mind that making generalizations about whether or not a given woman's meth use will "cause" these would be a massive overgeneralization — include:

I didn't emphasize the "mays" in that quotation, but I hope you noticed them.

My point here isn't that using meth (or any other drug, including alcohol, tobacco, or prescription medication) is a-ok during pregnancy. Using meth or drinking heavily or smoking isn't a-ok even when you're not pregnant — duh. My point is that simple judgments about drugs' effects on pregnancy aren't supported by the science; even when we know that in general X drug tends to cause Y outcome, that isn't the same thing as saying that this specific user is going to have that specific result. The most one can say is that it puts a user at an elevated risk for that result.

And there are things that we can do to mitigate those risks. Again according to SAMHSA, the critical factor in a child's outcome is not the simple fact of use itself, but the home environment. The consequences of use — or even of a poor home environment — can be mediated if we actually care about the child's well-being more than we do about casting blame on the mother.

One of the most effective solutions to the problem of mothers using meth is formally prioritizing families with children in treatment programs. Meth users, in fact, have:

* the highest "satisfactory" outcome after treatment programs, at 65.6%;
* the highest result for ongoing reunification services between mother and child when a baby that's been removed from the mother (usually after being tested for the presence of a drug at birth--which by the way, isn't done routinely--so there may be babies with meth problems that we don't know about, *and* there may be babies born with meth in their systems who are doing fine) and the mother is offered treatment — rather than incarceration;
* the second shortest amount of separation between mother and baby in these cases. The shortest separation time is for babies who tested positive for marijuana.

In short, as the Supreme Court of Hawaii found in the first case there where a woman was arrested for meth use during pregnancy, arresting pregnant drug users

For what it's worth, I've met the woman who was prosecuted in that Hawaii case. Her baby was born premature, and died after being released from the hospital (raising the question of why, if his health was compromised at birth, the hospital released him). Prosecutors assumed his death was the result of her having smoked meth a few days before delivery. After getting clean and getting through her prosecution, Tayshea Aiwohi has gone on to establish a foundation to help women recover from drug addiction and be reuinted with their children. It's named after her dead son. Seems to me she's doing a lot more good than the prosecutors who wanted to lock her up and throw away the key.

Bitch_PhD, being a liberal, is objectively pro-drug use.

Why do I care about the rights of pregnant meth users? Let's start small.

For most "respectable" women, the main thing you'll be told when you get pregnant is "don't drink alcohol." In fact, let's grab a beer out of the fridge and look at what the warning label says:

Everyone who drinks has seen these warnings, right? So we all know — and when you're pregnant, your doctor will remind you — that pregnant women shouldn't drink.

Notice, in fact, that while pregnant women "should not" drink, non-pregnant women — and men — aren't told what they should, or shouldn't do. They're given the facts — drinking "impairs your ability to drive" and "may cause health problems" — and expected to make their own, informed, decisions. Pregnant women, on the other hand, are told directly what they should do.
There are two implications here: first, that pregnant women are less able than men or non-pregnant women to think for themselves; and second, that alcohol is more dangerous for pregnant women (or their fetuses) than it is for "normal" people.

The first implication — that pregnant women can't think for themselves — is obviously stupid and insulting. If you're like me, when someone tells you what to do, you're inclined to tell them to fuck off. But before we tell the "don't drink while pregnant" crowd to fuck off, let's see what the problems with drinking while pregnant actually are — after all, it's a Big Deal, this pregnancy thing, and we wouldn't want to let knee-jerk attitudes about being grownups (after all, we're pregnant! How much more grownup can you get?) affect our judgment.

So let's move on to the second implication. Is alcohol, in fact, more dangerous for pregnant women than it is for everyone else? To find out, I'm consulting Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome and the Diagnosis of Moral Disorder. I stole the title of this post from the book, by the way. According to the author, Elizabeth Armstrong,

Five percent of children born to alcoholics. That ain't much. I think it is fair to say, without dismissing the importance of FAS, that most "normal" women — the kind of women who read alcohol warning labels, who see doctors during pregnancy, who are inclined to think about what they eat and drink — do not have much to worry about. Alcoholics, by and large, don't read warning labels and are far less likely than most of us to get decent prenatal care (which may, in and of itself, be a big part of the problem). If you care about FAS, your primary concern should be helping pregnant alcoholics get prenatal care, which includes treatment for their alcoholism.

Finally, let's don't forget that most women don't realize they're pregnant for a month or two. By which point, if you've been drinking, you've probably already done the majority of whatever damage you're going to do. IME, that ain't much; I went out drinking with my friends every weekend for two months before I realized I was knocked up, and as far as I and my kid's teachers can tell, he's smarter than most of the other kids on the playground. God knows, at 10 lbs 1 oz, he didn't have low birthweight (supposedly one of the markers of FAS). He's reading at grade level, his math is well above grade level, and he can tell you how DNA works, what a metaphor is, and how to build a working rocket.

So yeah. I'm inclined to say that drinking during pregnancy — by which I mean, "drinking during pregnancy by women who aren't alcoholics" — is okay. I'm inclined to think that people who claim that there are "tons" of kids with FAS in public schools are talking out their asses. I'm inclined to think that people who give you the fisheye when you order a cocktail in your seventh month are judgmental assholes. And I'm inclined to think that a lot of the hype around women's "responsibility" not to drink while pregnant is a big, guilt-tripping load of bullshit.

Bitch_PhD likes a good fight, and thinks people who pass judgment on pregnant women need to be smacked.