As more studies reveal the extent of the opioid epidemic across the United States, pregnant women battling a substance abuse addiction—specifically with prescription opioid painkillers and/or heroin—are being highlighted as a “priority population.” Every 25 minutes a newborn baby is born with a physical dependence on opioids or neonatal abstinence syndrome (NAS), pushing the need to find help and treatment for pregnant women and their fetuses at an ultimate high.
The drastic increase for opioid addiction in newborns and pregnant women has triggered new laws passed by some states in attempts of trying to regulate the issue, but which has only intimidated pregnant women with untreated opioid addictions to go into hiding and avoid prenatal care. Living with the fear of being arrested for drug abuse and/or losing their baby to child services, thousands of women are putting their and their child’s safety at risk.
Every day they wonder, is there a place for them to get help? Can a woman addicted to opioid painkillers and/or heroin truly be a mother to her child? Or is she doomed for failure at the start?
An Opioid Epidemic with No Limits
The United States is undergoing a severe heroin and opioid painkiller epidemic—and numbers aren’t declining anytime soon. Accidental overdose death rates have quadrupled since 1999, marking 165,000 lives lost. Despite more governmental effort to hammer down on grossly high opioid prescriptions and halt drug circles from spreading across the nation, the fact is that the heroin and opioid epidemic is taking over, manifesting among pregnant women and their neonates.
The numbers have been drastically increasing since 1999 in every way, but what causes for major alarm is the amount of NAS births occurring each year. Between 2000 and 2009, the number of NAS hospital births tripled, raising from 1.20 per 1,000 births to 3.39 per 1,000 births, which might not sound like much at first—until you realize that’s about 4 million babies.
Although the first spike occurred in 2009, that was five years ago and the numbers have kept growing. While 4.4 percent of pregnant women ages 15 to 44 in the United States admitted to taking illicit substances in 2009, this number would rise three years later at 5.9 percent in 2011-2012. This increase in opiate usage also increased NAS births, with studies stating that there were 5.8 per 1,000 births born with NAS in 2012.
From 1.2 per 1,000 births in 2000 to 5.8 per 1,000 births in 2012, the rates have quadrupled and continue to grow as current censuses evaluate today’s numbers.
The Severity and Shame That Comes with NAS
Neonatal abstinence syndrome occurs in a newborn infant when the mother uses illicit substances during pregnancy, thus forcing the baby to be physically dependent on the substance. NAS births can be caused by several substances, from alcohol to cocaine to heroin/opioids, but with extended stays at the hospital and depending on the severity of the substance abuse, infants can be restored to proper health again. Despite that, children born into addiction don’t normally get happy endings.
It’s a general rule that pregnant women should never take any form of substance during pregnancy for the safety of the fetus, which for most of the population is understood as alcohol and cigarettes, but the rules are different when a woman addicted to heroin and/or opioid painkillers finds herself pregnant and with an impending deadline weighing on her shoulders.
People with a heroin/opioid addiction can’t simply go “cold turkey,” cutting the substance out of their life, and this goes double for pregnant women. To begin the recovery process for opioid addiction, the substance abuser must go through detoxification under medical supervision, which requires medication maintenance to substitute and wean the addict off the opioids. For pregnant women, this usually means being prescribed methadone or buprenorphine along with prenatal care and a comprehensive drug treatment plan.
Why can’t they just quit? Well, withdrawal from any substance is stressful in general and thus not an ideal situation for a pregnant woman, but opioid withdrawal specifically could potentially lead to miscarriages or stillbirth. So while the mother might wish to kick the habit right then and there for her baby’s sake, it would be too much of a physical danger. The reality is that women struggling with addiction who suddenly become pregnant have to choose the lesser of two evils by maintaining their health with methadone and going through real detox after birth.
Still, there are many women who do not seek treatment for their addiction and then give birth to babies with NAS. Newborns suffering from opioid withdrawals can be born with several ailments from the abuse, namely: low birth weight, breathing difficulties, hypoglycemia (low blood sugar), convulsions/shaking, diarrhea, seizures, and a high sensitivity to their surroundings that leads them to cry at high-pitch levels.
Why pregnant women don’t seek treatment is a result of state lawmakers’ attempts at regulating opioid addiction and NAS births—along with the usual stigma of pregnant women who battle addiction. Most of these pregnancies are unplanned, leaving the mother uncertain and scared about what they could mean for her substance abuse. These women did not choose to be pregnant and then take substances; they were taking substances and happened to get pregnant.
Shame is a huge issue that hinders women from seeking help, both before and after pregnancy, which can lead to postpartum depression for the mother and death for the child—in some cases, the mother as well.
When Law and Order Don’t Mix
Another factor that hinders pregnant women from seeking help is the law. State lawmakers have been treating this issue as a crime instead of a health concern, assuming that fear of “getting caught” would inspire less substance use during pregnancy and thus healthier babies, but this backfired immensely.
Tennessee was the first state to enact a law in 2014 that expressly criminalized drug use during pregnancy. This meant that police officers would arrest women who gave birth to babies with NAS or who, upon giving urine samples during pregnancy, tested positive for substance abuse. Currently, five other states—Alabama, Colorado, Louisiana, North Carolina, and Virginia—are all considering enacting similar laws.
If it was meant to be a scare tactic, it succeeded, but it did not succeed in preventing NAS births. Women were more afraid of testing positive during prenatal care and thus losing their child as they went off to prison than attempting to go clean on their own and keep their baby. Knowing the health concerns with trying to detox off opioids on your own, one could imagine the horrible consequences. Women were going underground to avoid penalty, giving birth in different states or in the backseat of cars. Some women took their own lives. It was such a disaster that Tennessee decided in March of 2016 to take “fetal assault” off the books, effective in July.
Perhaps experimenting with trying to scare women into treatment was doomed from the start, but there is also an issue when absolutely no form of enforcement occurs to intervene dangerous family environments and stop preventable deaths.
Back in 2003, the Keeping Children and Families Safe Act was passed and required “states to set up systems to ensure that medical personnel alert child protection works to newborns ‘identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure,’” but studies found that most states ignore this law or provided exemptions—albeit well-intended ones—that would ultimately bypass enforcement.
For example, if the mother was undergoing methadone maintenance for her heroin/opioid addiction during pregnancy, many states don’t require hospitals to report her case to child services, under the assumption that she will fully recover and lead a healthy lifestyle. This was to allow privacy for the mother and her child, as well as avoid further stigma, but which also ignored that methadone is not a cure-all for opioid addiction. Without follow-up appointments and proper detox rehab for the mother, she and her baby would be doomed from the start the moment they left the hospital.
Right after birth, a mother is susceptible to great periods of stress. She’s tired, depressed, anxious, guilty, ashamed—a cocktail of unpleasant emotions; she’s bound to relapse just to calm down and deal with the pressures of motherhood. Without having child services come in and monitor them as recovering addict mothers, many tragedies occurred as women relapsed and proceeded to neglect and/or abuse their children, leading to their deaths.
A Need to Help These Women
Unfortunately, the amount of treatment centers that service pregnant women are small and few. Even if a soon-to-be mother attempts to help herself, she doesn’t have many places to go—and even if she did, she might have to wait in line.
Because pregnant women would require intensive care, too many treatment centers tend to not accept them into the program, not wanting to deal with the legal and health issues associated with them. Treatment centers that do welcome pregnant women don’t meet the demand with their supply of professional doctors, therapists, and available beds. Because this is a massive epidemic across the country, this issue then becomes heavily community-based and requires more awareness to state officials to open up more clinics.
All does not have to be lost if people begin the discussion to help pregnant women battling with substance abuse and call for more treatment centers instead of prisons. When the stakes are saving the lives of future generations, what’s needed most is a national community.