For Addiction-Infected Infants, Punishing the Mother Is Not a Cure

These numbers are heartbreaking. Approximately 32,000 newborns are diagnosed annually in the United States with neonatal abstinence syndrome, a form of withdrawal that can result from in utero exposure to a variety of drugs taken by the mother. Prescribed and illicit opioids are among the most prevalent offenders. These medications may be essential, even life-saving, but that does not make the resulting NAS easier to observe. Symptoms of the syndrome include tremors, irritability, hyperactive reflexes, and high-pitched crying.
However, drugs are not the sole cause of the prolonged suffering experienced by many of these infants. The manner in which NAS cases are handled has a significant impact on their severity and frequently results in negative outcomes. Historically, health care professionals and law enforcement authorities have separated these fragile infants from their mothers, meting out harsh punishments to the mothers. Although awareness of the need for change is growing, many hospitals continue to use outmoded methods, and child welfare agencies are particularly lagging in this area. Recent studies suggest that policies that place blame on mothers exacerbate the suffering of newborns by preventing them from receiving effective treatment for withdrawal symptoms. contact with mom.


Curable Hypertension Largely Overlooked Misconceptions about opioid dependence, addiction, and NAS are woven into the very fabric of United States and state law. In order to receive federal funding for child abuse prevention, health care workers must notify Child Protective Services of newborns affected by substances. In addition, states can require health care providers to report drug exposure during pregnancy or to test for it. In many instances, mothers are reported even when the exposure is the result of methadone or buprenorphine, two commonly prescribed opioid-based drugs used to treat addiction.
In Alabama and South Carolina, drug use during pregnancy is a crime, and North Carolina is currently considering a bill that would expedite the termination of parental rights in certain cases involving parental drug use during pregnancy.
According to the Guttmacher Institute, a research organization that advocates for reproductive rights, drug use during pregnancy is considered child abuse in 23 states and the District of Columbia, sometimes regardless of whether a substance was prescribed or the mother had reasonable access to evidence-based addiction treatment. According to a recent study by the RAND Corporation, states that adopted punitive policies for pregnant women who use drugs saw an increase in newborn withdrawal, indicating that these policies end up harming the very infants they are intended to protect.
Even when the law does not conspire to separate mother and child, providers of health care frequently do so. It is common practice to send newborns exposed to opioids to the neonatal intensive care unit, where they are exposed to bright light, surrounded by loud noises, and separated from their families for extended periods of time. If not supervised by a social worker, mothers accused of child neglect or abuse may be prohibited from visiting their children.
The very fabric of federal and state law is woven with misconceptions regarding opioid addiction, dependence, and NAS.
However, scientific evidence suggests that these interventions that limit a baby’s time with the mother may be counterproductive. Studies indicate that maternal contact, breastfeeding, and co-sleeping with the mother reduce symptoms in newborns exposed to opioids.
According to John McCarthy, an associate professor of psychiatry at the University of California, Davis who has worked with pregnant patients undergoing methadone and buprenorphine treatments for over four decades, babies need their mothers. He adds that babies exposed to opioids in utero have a special need for their mothers because they are susceptible to withdrawal and the mother can help reduce withdrawal symptoms.
Researchers at the Yale School of Medicine, Children’s Hospital at Dartmouth-Hitchcock, and Boston Medical Center have recently devised a treatment strategy to prevent the unwarranted separation of mothers and newborns with NAS. The Eat, Sleep, Console protocol only considers administering medication when a newborn fails to eat well, cannot sleep for more than an hour after feeding, or has crying spells that cannot be soothed within 10 minutes. Even in such cases, nurture-based interventions such as swaddling, on-demand feeding, and maternal contact are preferred over alternative treatments. As needed, low doses of morphine are administered. In contrast, conventional guidelines for treating NAS, such as popular interpretations of the Finnegan Neonatal Abstinence Scoring System, escalate more rapidly to pharmacological interventions.
In a preliminary study involving 50 newborns exposed to opioids, the Eat, Sleep, and Console method demonstrated promise. Matthew Grossman, a pediatrician at Yale University and one of the study’s authors, states: When we began doing this, the average length of stay for babies experiencing withdrawal was 22.5 days. 98% were administered morphine. Since adopting the Eat, Sleep, Console method four years ago, the average length of stay has decreased to six days, and only 10 to 15 percent of NAS patients have received morphine.
Even when the law does not conspire to separate mother and child, providers of health care frequently do so.
Eat, Sleep, Console has reportedly been implemented in North Carolina, Massachusetts, and California hospitals. Even hospitals that continue to use the Finnegan scale are increasingly permitting mothers to stay in the same room as their infants. Some hospitals employ volunteer cuddlers who comfort crying infants when family members are unavailable.
Despite this, numerous hospitals and child welfare agencies continue to engage in practices that contradict the science of opioid addiction and its punitive treatment practices, even for mothers enrolled in doctor-supervised rehabilitation programs. According to one mother in Massachusetts, her participation in a treatment program was used to justify neglect charges based on her history of substance abuse and mental health issues.
To neonatologist Loretta Finnegan, who has worked with opioid-exposed newborns and their mothers for over 50 years and developed the Finnegan scale for assessing NAS, the stigmatization of mothers receiving treatment is unfair. She says [child services] should not say that this mother has harmed or abused the baby because the baby went through withdrawal because the mother is on methadone and the withdrawal is essentially a side effect of medication that the mother has been prescribed by a licensed physician.
Numerous hospitals and child welfare agencies continue to engage in practices that contradict the scientific understanding of opioid addiction and its treatment.
Finnegan has exerted great effort in New Jersey, where she has provided expert testimony on behalf of mothers, to persuade state authorities that NAS is a normal side effect of some medications and should not be considered abuse for women in treatment. The New Jersey Supreme Court ruled in 2014 that withdrawal from prescribed methadone could not be the sole basis for an allegation of child maltreatment. However, the decision does nothing to protect the mother-child relationship when opioid treatments are obtained without a prescription.
Finnegan states that there are instances in which a mother refuses to see a doctor for treatment and instead purchases buprenorphine on their own. She says that these cases are extremely challenging because the state considers drug use to be illegal. She acknowledges, however, that there are often valid reasons why a mother might be compelled to purchase nonprescription medications on the black market. Some mothers cannot afford treatment due to financial constraints. Some mothers live too far away, and some women who visit a program are told, “We do not accept pregnant women because they lack the support of a medical doctor and we do not want the liability.”
Fallon Speaker, an assistant clinical professor and director of the Jeanette Lipman Family Law Clinic at the University of Richmond School of Law, is troubled by the narrow focus of some jurisdictions on drug use rather than harm or risk of harm to the child. She states that many of her clients were active drug users, but posed no danger to their children, as acknowledged by courts and child welfare agencies. The policy, however, was zero tolerance.


Sent Weekly This dogmatic emphasis on substance-free bodies disregards medical science and can lead to mothers taking dangerous risks. While researching a story for the digital magazine Filter, I interviewed one mother, Keri Ballweber, who said she purchased several months’ worth of buprenorphine while pregnant and unable to access formal treatment for her heroin addiction. To avoid detection when she gave birth, she weaned herself off buprenorphine over a period of several months, which is not medically recommended during pregnancy. Ballweber was fortunate; her child was born healthy and without withdrawal symptoms. The fact that she was compelled to take such a risky action, however, demonstrates how a credible fear of punishment can discourage women from receiving proper care and encourage risky self-medication.
There is no doubt that the politics of drug addiction in the United States have a contentious past. Many individuals, including policymakers and some treatment professionals, continue to consider drug abuse a moral failing. It is particularly easy to become enraged at the thought of a newborn enduring the agony of opioid withdrawal during her first days of life. But this anger should not drive policy.
In reality, maternal connection and bonding during a newborn’s first days are beneficial for both mother and child. This is true whether a child was exposed to prescription or nonprescription drugs. A mother’s touch is as soothing for an infant withdrawing from illegal opioids as it is for an infant withdrawing from legal opioids, regardless of their legality.
Punishing and shaming mothers with substance use disorders only diminishes their self-esteem and causes emotional trauma. Or, as UC Davis’ McCarthy puts it bluntly, Don’t separate mother and child. If you do so, the infant will deteriorate.


Opinion | Many neonatal care units and child welfare agencies have adopted practices that defy the science of opioid addiction.