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When mom's an addict, so is her baby
Drug addiction is a sad reality on the Seacoast and across the country and often the smallest, most innocent victims are the ones with no choice.
It is a fact that pregnant moms share their behaviors with their children. Drugs easily cross the placenta, so when a mother is using, so is her baby. The result is a baby born who must now face his or her first hard life trial – withdrawing from the drugs used by mom.
Dr. David Rich of Dover Pediatrics said he does see children whose mothers were involved with illegal drugs, and those who are addicted to prescription narcotics such as the pain killer Oxycontin.
"I don't see a lot of it in our clinic, but I see it frequently in the hospital setting," Rich said. "I will be called in as an attending at the birth and we immediately begin monitoring the child for signs of withdrawal."
There's a name for it. Neonatal Abstinence Syndrome is identified by "scoring" the infant for signs of certain behaviors when the mother's drug history is known.
"We look at how they are feeding, how they sleep and how long they sleep for," Rich said. "We watch them for jittery behavior and gauge the quality of their crying. We analyze their stool samples. It's often hard to be sure because, well, all babies cry, but a pattern and the history is a good indicator."
Treatment for the affected infants involves the use of small doses of morphine, adjusted as needed until the baby's withdrawal symptoms subside.
"It's called capturing the symptoms and we work with the morphine until they score lower on the scale," Rich said. "Once we see that control, we maintain that dose for 48 hours and then begin to wean the baby off the drug. If there is no return of the symptoms, the baby is ready to be released."
Whether the baby is released to the mother or into foster care depends on the situation. Rich said the state is always involved if there is a recognized drug issue.
"We will try to get the mother into a drug treatment program," he said. "(The Division of Children, Youth and Families) will assess the family and the home to determine if it is a safe environment for the child. The women involved are in a bad situation themselves, so having them in a drug treatment program is certainly better than their being out on the streets. And, understand we are not always talking about people on the lower end of the economic scale. Women of any social group can and do develop drug problems."
Dr. Robert Cervenka, an OB/GYN at York Hospital in Maine, said the first step is often to look for signs of addiction in the mother, because they may or may not be up front about it.
"It's mandatory to screen mothers for drugs when we know, but it is not legal to just screen everyone, so it can be tricky," Cervenka said. "Mothers with a drug problem are told they will be sent to Maine Medical Center, to the NICU (neonatal intensive care unit) and they will be screened regularly. So some, often those who are homeless and have no insurance, will be non-compliant and just show up at different hospitals at the time of delivery. They are trying not to lose their babies. I screen women with known risk factors and some women will just tell us that they are in a program or were in the past."
Efforts are made while the baby is in utero to address the mother's drug problems, said Dr. Mark Chag, an OB/GYN at Portsmouth Regional Hospital.
"Many of the women are nice women who have made some really bad decisions," he said. "They really want to protect their children and will try their hardest to control their drug use while they are pregnant. Some of the treatment centers believe the mom needs a higher dose while pregnant and we have to work against that perception. Sometimes the moms try to hide it, but I think most are up front because they do care about their babies."
Heroin is the most common illicit drug that doctors caring for pregnant mothers see today.
"It changes," Chag said. "It used to be cocaine. Then it was crack. Now heroin is the most common. I don't understand it, but I do see addicted moms who will have addicted babies more than I wish I did."
Chag said it's not always hopeless. He has seen moms who turn their life around for their child.
"Sometimes the clinics will give a higher dose of methadone and the moms will take half," he said. "They want to do what they can for the health of their child. We tell them we are not here to judge them. We want them to have a healthy baby that they will be able to keep."
Low birth weight is a common trait in babies born to addicted mothers. Unlike fetal alcohol syndrome, however, the long-range effects on the health of an infant who must withdraw from drugs are not readily apparent.
"There may be some neurological development issues," Rich said. "We watch their development and behavior as they grow. Treatment at birth and as they grow is a team effort. It involves doctors, nurses, the medical team and the family. Good communication is so important."
Karen Dandurant
19 May 2013
http://www.seacoastonline.com/articles/20130519-LIFE-305190318
