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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.

Maternity care and substance misuse

Yalile Seaman

Reprinted from "Women's" issue of Visions Journal, 2004, 2 (4), p. 42-43

Fir (Families in Recovery) Square

In January 2003, BC Women’s Hospital opened the Fir Square program, which provides maternity care for women struggling with substance misuse. Women are admitted to the unit for withdrawal management and stabilization. Length of stay ranges from one day to several months, depending on the woman’s degree of instability. Women can be admitted several times during their pregnancy based on their needs and commitment to participating in the program.

Following a harm-reduction approach, the program’s goals are to reduce the substance use and risky behaviour of the women and to have more women go home with their babies postpartum. Women are at different stages of readiness to change their lifestyle; therefore, they guide their own care planning.

A multidisciplinary team is available to support these women. The team consists of nurses, physicians, a senior practice leader, a dietitian, a social worker, an alcohol and drug counsellor, an infant development worker, a spiritual care worker, music and recreational therapists, and a reproductive mental health psychiatrist.


Fir Square has a ‘roomingin’ philosophy based on family-centred care—i.e., keeping mother and baby together on the ward. Rooming-in strengthens a mother’s caregiving skills and her confidence to parent, offering the mother the possibility of going home with her baby.

The program has found that the number of babies experiencing withdrawal and the number of babies requiring treatment with morphine is lower when mothers are the primary caregivers. Babies are supported through the withdrawal symptoms that usually begin within the first three days after birth.

A baby’s readiness for discharge is based on the objective measure of weight gain over two or three consecutive days.

Care Planning and Delivery

The Fir team plays a valuable role in empowering the mother to have a stronger voice and to increase her participation in the process of determining what is best for the baby. There are weekly care planning meetings with the Fir team, the woman, her community supports, and Ministry of Children and Family Development (MCFD) workers to facilitate a consensus decision-making process that addresses family needs as early as possible. An educational component about substance use and the effects on babies has proven beneficial for all parties involved in planning for a baby. The protection concerns and expectations of MCFD are clarified to ensure families are in safe home environments. In terms of evaluating a mother’s parenting capability, Fir staff acknowledge the research that says that women with babies in their care relapse less often.

On evaluation forms, women have reported a sense of self worth and a greater bond with their babies as a result of opportunities to parent while at Fir and after leaving the hospital. If a baby is going into foster care, the foster parent is required to have teaching sessions with the infant development worker, and with the mother and baby at least once before they are discharged from Fir. The rapport building between mother and foster parent is extremely important when mothers are working towards parenting in the future. It can influence the frequency and quality of visits the mother makes to the foster home after discharge from Fir.

The program tries to address identified gaps in the continuum of care for pregnant and early postpartum women with addiction issues, and advocates for safe housing, treatment and parenting programs, financial and legal aid, and dual support. Fir Square has a close partnership with community resources that provide a wide range of services for pregnant women and women with children up to 18 months. A long-term goal of the Fir program is to create a second-stage house and treatment program for women on methadone and their babies; the lack of this type of support prevents families from staying together.

The care providers at Fir strive to improve service delivery. Staff have seen improved perinatal outcomes, including increased birth weights, a decrease in infants requiring treatment for withdrawal, and an increase in mothers who are able to safely retain custody of their newborns. Educational workshops are organized to facilitate connection with health care providers throughout BC. Data is also being collected for research purposes—to highlight the need to change how maternity care is provided across Canada.

It is essential that as a society we recognize addiction issues and the challenge of caring for these families in the context of poverty, community disconnection, and limited funding for social programs.

About the Author

Yalile is the Fir Square social worker. She has a master’s degree from UBC, where she focused on health care and community development


For referrals to the Fir inpatient unit, call (604) 875-2229; for the Thursday outpatient clinic, call (604) 875-2160

Relevant Resources


  1. Covington, S. (1999). Theoretical perspectives: How addiction works and how women recover. In Helping Women Recover: A Program for Treating Addiction. San Francisco: Jossey-Bass.

  2. BC Reproductive Care Program. (1999). Principles of perinatal care of substance using women and their infants; and Discharge planning guide for substance using women and their newborns. Substance Use Guidelines 1 & 2. Retrieved November 15, 2004, from the BC Reproductive Care Program website:

  3. Hepburn, M. (1993). Drug misuse in pregnancy. Current Obstetrics and Gynaecology, 3, 54-58.

  4. Johnson, K., Gerada, C. & Greenough, A. (2003). Treatment of neonatal abstinence syndrome. Archives of Disease in Childhood Fetal and Neonatal Edition, 88(1), F2-F5.

  5. Kennell, J.H. & Klaus, M.H. (1998). Bonding: Recent observations that alter perinatal care. Pediatrics in Review, 19(1), 4-12.

  6. Lvoff, N.M., Lvoff, V. & Klaus, M.H. (2000). Effect of the baby-friendly initiative on infant abandonment in a Russian hospital. Archives of Pediatric & Adolescent Medicine, 154(5), 474-477.

  7. Nishimoto, R.H. & Roberts, A.C. (2001). Coercion and drug treatment for postpartum women. American Journal of Drug & Alcohol Abuse, 27(1), 161-181.

  8. Richter, K.P. & Bammer, G. (2000). A hierarchy of strategies heroin-using mothers employ to reduce harm to their children. Journal of Substance Abuse Treatment, 19(4), 403-413.

  9. Poole, N. & Isaac, B. (1999). Apprehensions: Barriers to Treatment for Substance-Using Mothers. Retrieved November 15, 2004, from the BC Centre of Excellence for Women’s Health website:

  10. Prodromidis, M., Field, T., Arendt, R. et al. (1995). Mothers touching newborns: A comparison of rooming-in versus minimal contact. Birth, 22(4), 196-200.

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