Well….since you brought it up…..
At first I wasn’t sure what I was supposed to say to this. Should I relive one those nights I walked around the unit, bouncing a screaming infant in my arms that wouldn’t stop crying? Talk about all the methadone I dispense on a daily basis? Tell the story of that time a heroin dealer tried to get on the unit? I could easily write an emotional story about one of the addicted babies I’ve cared for, like one of the many other touching-nurse-story-time posts. Everyone would comment how terrible it must be to work with NAS babies, how heart breaking, “I’m not crying, you’re crying!”, how awful those mothers are. I almost responded to this with a simple “Of course it’s horrible!! What could I possibly say besides, ‘Yes, of course it’s awful!’”
I didn’t respond with any of that, though, because there actually is a lot more that I can say. And what an opportunity this presents to talk about something important!
Where I work, we see addiction in neonates a lot. Drug use during pregnancy is a common cause of cardiac defects. It’s very easy to focus on how terrible these babies cry, how awful the mothers are, ask how someone could be so selfish, then move on and not consider the issue more thoroughly than that.
Honestly, the cries of an addicted baby end fairly quickly. Sure, newborn nursery nurses will probably tell you all about how inconsolable they are, but that’s not the end of the story. They get put on drugs, stop withdrawing, and are weaned off. If they start withdrawing again, we put them back on drugs and wean slower. Is this ideal? No. Are there consequences? Probably (long term effects have not been fully studied). Is this the worst possible thing that could have happened to baby? Well….no. NAS is treatable. I actually see more addiction caused by ICU sedation than maternal drug use. Having babies on a methadone/ativan wean and stickered with clonidine patches is incredibly routine (am I saying that makes it ok? No. But it’s not irreparable!)
Before we go any further in this, I want to make it clear: NO, I’m not saying it’s OK to use drugs during pregnancy. Obviously drug use can be extremely harmful to the baby (e.g., the cardiac defects they ultimately end up in my unit for). I don’t want to diminish the seriousness of NAS, but I think there are more effective ways of preventing it than only talking about it in terms of heart-break and guilt. Addiction is not without hope.
The mothers of these babies are not simply “addicts.” They are mothers. And they are usually not terrible. Most of them cry, most of them are terrified about what’s going to happen to their baby, most of them are overwhelmed with regret, most of them beat themselves up and stand over their baby’s warmers apologizing profusely, most of them swear to me over and over that they’re getting clean and they want to be there for their baby (even though I never even bring it up). They feel awful. They take it seriously. They’re scared. They get it.
Some of these moms had prescriptions. I’ve met a mom with a severe anxiety disorder who needed to continue her medication use to keep herself well though the pregnancy. Yes, that’s moral grey-area, but it’s a tough situation she tried her best during. I’ve had mothers who were in the process of getting clean and using methadone when they became pregnant. Some moms want to get clean, but a lot of rehabs refuse to take on pregnant patients. Quitting cold can be really hard on a mom and fetus. Some women are terrified that if they do seek help, they’ll be arrested or have their baby taken away from them. That they’ll be shamed and judged and no one will help them anyway. This fear often prevents them from seeking prenatal care at all. There was actually an article on NPR a few days ago exploring this, and fetal assault laws in Tennessee.
So what am I trying to say? Yea, it’s sad that a baby can withdrawal. Maternal drug use is sad. NAS is sad. It’s all so sad, sad, sad. But is it the end of the world? Is it all we should talk about? No. Maybe if we stop villainizing mothers and focusing so much on “how terrible!” the situation is, we can start focusing on how to help them. Instead of talking about how heartbreaking it all is, we can talk about how there is hope. Mothers can get through this, their baby can get through this, they will be supported, they will be ok. They and their baby can conquer drug addiction. Maybe they made a bad mistake, maybe they were in a terrible situation, but if they love their baby and want help it should be available. We can help them. We will help them. They will both make it through this. There is recovery, there is hope. And that is happy!