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addressed simultaneously, treatment is not likely to be successful. It
is necessary to assess thoroughly and repeatedly in an effort to
understand the patient’s life situation, so that a comprehensive plan
can be formulated which allows the patient to achieve abstinence.
Barriers to participating in treatment must be identified and dealt with.

Participation in individual and group counseling at the program is a
critical part of treatment. Perinatal programs often offer classes about
addiction, recovery, pregnancy, parenting, healthy relationships and
life-skills. Mommy and Me programs teach women how to care for
and play with their infants and young children. Parent Support Groups
encourage women to share their parenting challenges and concerns
and to learn from one another under the guidance of a knowledgeable
staff person.

The majority of women who are on methadone maintenance come
from very troubled family situations and received inadequate parenting
themselves, so need ongoing coaching, modeling and support. Many
Perinatal Programs have health educators on staff to teach women
about issues such as normal child development, dental hygiene, how to
feed a child, how and when to toilet train, etc. Referral to Public
Health Nursing may also be helpful, so that a nurse can go out to the
house to assess and assist.

In Utero Methadone Exposure and the Neonatal Abstinence
Syndrome

Fetal methadone exposure is known to be safer than fetal heroin
exposure or fetal opioid withdrawal. Methadone has been used and
studied for 40 years. As NIDA states, “Research has demonstrated
that the effects of in utero exposure to methadone are relatively
benign.” There are no known birth defects associated with its use
during pregnancy. Methadone Maintenance of the opioid dependent
woman increases the likelihood that the mother will participate in
prenatal care and that the baby will be born at term.

Methadone exposed babies generally have lower birth weights/smaller
head circumferences than non-opioid exposed babies, but higher birth