Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice

Drugs are bad

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Just one of those inconsistencies

Condemnation is a typical response to mothers who ingest opioids while pregnant. But these women are at risk of receiving much more than a scolding: they may lose their state benefits, their children, and their liberty. Mandatory reporting laws in many states turn health care providers into informants who connect the dots between health care, child welfare authorities, and law enforcement. Reporting of drug-using pregnant people is heavily racialized.

These same health care providers and institutions, however, are content to fix up their laboring patients with epidurals that contain opioids. Epidurals certainly make patients quieter, as the provider in Frame 2 suggests; they are also increasingly demanded by patients who are not permitted to move around during labor, whose contractions have been artificially strengthened with Pitocin, or who are experiencing long labors as a result of physiologic responses to the hospital environment.

Note: No one is suggesting that women in labor should not receive epidurals, only that patients should not be tricked or coerced into epidurals for providers’ benefit, and that patients should have true informed consent with explanations of both benefits AND risks.

Emerging evidence suggests that people exposed to opioids in utero are more likely to develop opioid addictions later in life. We hope that this recognition does not trigger greater retaliation against opioid users who face the sanctions shown in Frame 1, but instead explores all the factors that shape a system that leads to opioid use of any kind by any birthing person.

Further reading

  • Michelle Alexander, The New Jim Crow: Mass Incarceration in the Age of Colorblindness, 2011.
  • Lynn M. Paltrow, “Roe v Wade and the New Jane Crow: Reproductive Rights in the Age of Mass Incarceration,” American Journal of Public Health 103, no. 1 (2013): 17–21.
  • Khiara M. Bridges, The Poverty of Privacy Rights, 1 edition (Stanford, California: Stanford Law Books, 2017).
  • Kajsa Brimdyr and Karin Cadwell, “A Plausible Causal Relationship between the Increased Use of Fentanyl as an Obstetric Analgesic and the Current Opioid Epidemic in the US,” Medical Hypotheses 119 (October 1, 2018): 54–57, https://doi.org/10.1016/j.mehy.2018.07.027.

Image credits

All images are shared under a Creative Commons license, unless otherwise noted. Where required by license, changes to the image are noted.

  • Frame 1: The pregnant woman is by creativeitchalways. She was originally holding an orange drink; it was replaced by an orange water bottle created by alistairjtp. This image is in the public domain. The doctor’s office background is by annekarakash. The pointing hand is by Tumisu; the white sleeve was added later. The police officer’s hand is by Andrew Griffith; it is isolated from a much larger image of a police officer standing with his arms crossed. The handcuffs are from Needpix.com.
  • Frame 2: The laboring woman is from Max Pixel. The doctor’s office background is by Omar Bárcena; the image shown is a much smaller piece of the original photo. The downplaying hand is by truthseeker08; the white sleeve was added later. 

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