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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Ron Abrahams

Reprinted from the "Having a Baby" issue of Visions Journal, 2012, 7 (3), pp. 26-27

Society has always blamed mothers who are pregnant and use drugs. Such attitudes have meant that the babies were separated from their mothers right after birth.

These babies then were withdrawing—not from drugs that their mothers used, but from not being with their mothers.Not only was this hard on the babies, it was also hard on the moms.

This standard of care led to the mothers not coping and being further traumatized than they already were in their lives. It also meant that the babies—who exhibited abnormal newborn behaviour because of the separation from their mothers—were treated for long periods of time in hospital. Subsequently, most of the babies would end up in foster care. Most of the mothers would end up using and/or on the street, and the cycle would start all over again.

In Vancouver, we understand that with a non-judgmental, caring approach, this negative cycle of blame can be reversed. By stopping this blame cycle and supporting these moms in their desire to care for their babies, we can ultimately discharge them home with their babies.


Over the last 20 years, we developed the Sheway pregnancy outreach project in Vancouver’s Downtown Eastside. It is based on the following principles:

  • Supporting the moms to decrease the amount of drugs they use

  • Rooming-in the babies and mothers together following birth

  • Providing food, housing and health care

  • Continuing ongoing supportive care of these families in their community

  • Providing specific counselling programs in the context of trauma-informed care

In the Sheway program, a multidisciplinary team provides the women with health care, a drop-in centre, hot lunches, social work support, infant development and parenting support, legal help, and alcohol and drug counselling.

By providing trauma-informed care, we demonstrate our understanding that these women can be redefined from a dual diagnosis context. Through working with these women, we have learned that they are quite capable but suffer from the ongoing trauma and stress in their lives (e.g., sexual abuse, abusive families, foster care). This is a harm reduction program. It reduces the bad things that these women experience.

With counselling and support, we have shown that the women use drugs less, and more importantly, that we don’t have to prescribe medicines that can affect their babies (e.g. antidepressants or anti-anxiety drugs).

When these moms need to be in hospital, we admit them to Fir (Families in recovery) Square at BC Women’s Hospital. We also deliver their babies at the hospital and room-in their babies with them immediately after birth. We help the mothers with breastfeeding and holding and cuddling their babies.
We only let moms and babies go home if they have a safe home to go to. If they don’t, we keep them in hospital until housing has been arranged for them.

When the system cares

This is a program that brings together community and hospital to improve health outcomes for these families.

This program means that fewer babies are treated for withdrawal, more babies are breastfed, and fewer babies go into foster care. Over the last 10 years, about 1,200 women and their babies gone through Fir Square.

This program is governed by a partnership between Vancouver Coastal Health, the Ministry for Children and Family Development, Vancouver Native Health Society and the YWCA of Vancouver.

We are an example for every community in BC and Canada about what happens when the system cares for these women rather than blames them.

*Sheway is a Coast Salish word meaning "growth"

About the author
Ron is a family physician in Vancouver. He is a Clinical Professor in the Department of Family Practice at University of British Columbia and Medical Director of Perinatal Addictions at BC Women’s Hospital, as well as Consultant Physician at the Sheway program


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