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It's really hard to tell your doctor: "Hey, I'm pregnant and using heroin."

For babies born with neonatal abstinence syndrome, the first few days and weeks can be more challenging.
Flickr Creative Commons/London Looks
For babies born with neonatal abstinence syndrome, the first few days and weeks can be more challenging.

Sara and her husband always wanted to have a baby. They tried for years, but she’d been diagnosed with polycystic ovarian syndrome, so she eventually accepted it wasn’t in the cards for them.

Then, she went to jail.

“And um, I ended up getting in trouble with my addiction,” she says about the opioid habit that eventually turned into using heroin: a little bit every day, she says, just to feel normal. “And I went to jail for four months. And when I got out, the day I got out, I got pregnant.”

It felt like a miracle. Sara says she’d spent the four months in jail getting clean, going to counseling, and started taking short walks for exercise. So this was a not a miracle she intended to waste.

She quit smoking. She lost 130 pounds and began running long distance road races. She and her husband even picked up and moved to a new town in Northern Michigan, just to get away from the people she’d used drugs with.

But the cravings still made her nervous. And though opioid addiction isn’t a shameful secret anymore, it’s still not easy for a woman to tell her doctor: Hey, I’m pregnant…and did I mention I’m addicted to heroin?

“I’m nervous about telling people about that,” she says, sitting on a couch in the Munson Medical Center’s designed meditation room with big stained-glass windows. “But I got to get over that, you know? It will help people.”

Every year, hundreds of Michigan babies are born with opioid dependency

By now you’ve probably seen terrifying headlines about what happens when a baby’s exposed to opioids in the womb: it’s called neonatal abstinence syndrome, or NAS.

Every year, more than 800 babies in Michigan are born with NAS. (That’s according to the state health department’s 2014 numbers, since more recent data isn’t available yet. But even for 2014, that might be an undercount: that same year, Child Protective Services got 2,610 reports of infants testing positive for drugs.)

And yes, it’s painful for the baby, but in most cases, it’s treatable.

Just like when an adult weans off of a substance, babies can experience fever, vomiting, and in the most serious cases, possibly even seizures. Sometimes babies exposed to narcotics in the womb can be born prematurely or have birth defects. But your typical case, experts say, involves some heart-wrenching, inconsolable crying, tightened muscles, and gastrointestinal issues.

It’s expensive and time-consuming for hospitals, not to mention emotional for parents, but after a few days or weeks of extra care in the NICU, most babies are on their way to a full recovery.

We still don’t have solid answers about whether there are long-term developmental effects from NAS. Michigan doctors are studying that right now, tracking NAS infants as they grow into toddlers and young kids.  

Driving for hours to get to the doctor who treats pregnant women with opioid addictions

For Dr. Julia Riddle at the Grand Traverse Women’s Clinic, her practice is often focused around treating pregnant women with opioid addictions. Patients drive for hours from all over Northern Michigan to see her.

“Most moms, they want to keep their baby! And they may have had the worst past ever, but this is the moment that changes their lives,” she says. “They can get clean.”

And they’re facing so much guilt and shame, she says – even from their own families.

“They lock them in rooms to make them withdraw. Because they’re like ‘you shouldn’t be using when you’re pregnant,’” she says.

That’s actually the worst thing you can do, she says. Sudden withdrawal can cause seizures and miscarriage.

So when Sara reached out to Dr. Riddle, she prescribed her buprenorphine. It can treat addiction to narcotic pain relievers, and most importantly, keep women like Sara stable through pregnancy, so they’re not at risk of experiencing the huge surges and withdrawals that come from heroin use.  

Getting help, and dealing with the guilt and relief

Going to these doctor appointments regularly, and getting a prescription like this can help tremendously when CPS sees a baby’s tested positive for drugs.

“I knew the consequences, and I really wanted my kids so bad,” Sara says, her voice shaking. “I wanted to do the right thing, not knowing what that was.  And Dr. Riddle, she knew how to get me through it.”

But the buprenorphine, just like methadone, is still an opiate. And for Sara, that meant she worried constantly about her baby having NAS. But her daughter was born without any complications from opiates. Now, she’s a smart, chatty four-year-old and Sara’s voice softens talking about her.  

Then, just a few months after her daughter's birth, Sara got pregnant again. She kept taking the buprenorphine under Dr. Riddle’s supervision. And even this time around, there was that constant guilt: was this hurting her kids?

This time, when she gave birth, the baby did show symptoms of NAS: he had diarrhea, discomfort, a rash. Sara was the one who alerted the nurses, she says, because she’d been on constant alert for any sign of withdrawal. It meant a few extra days in the hospital. But by the time she took him home, he was settled.

"And he’s perfect," Sara says. "He’s the little boy I’ve always wanted.”

He’s three now. And Sara’s staying home with him, at least until he goes to school. She hasn’t talked to her kids yet about her past. The mom they know, she says, is the one they go cheer for when she’s running road races.

But when they’re older, she says, she might reach out to other moms going through opiate addiction. Maybe help them feel like it’s something they can talk about.

This story was corrected on 4/5/17 to change the description of Dr. Riddle's practice: treating pregnant women with opioid addictions is her focus area, but she also sees patients who do not have histories with opioid or substance abuse. 

This story was edited on 4/11/17, because after the story was published, Sara let us know she worried having her kids' first names in the piece might make them more identifiable to people who know them. While Michigan Radio doesn't usually make changes like that after an interview subject has already agreed to allowing names to be used, we felt respecting Sara's wishes was important here.  

Kate Wells is a Peabody Award-winning journalist currently covering public health. She was a 2023 Pulitzer Prize finalist for her abortion coverage.
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