Growing Problem : Babies Pay for Mothers’ Drug Abuse

Sherry Burns was a 10-year-old Costa Mesa girl on her way to a tough reputation when a teen-age boyfriend shot her up with heroin for the first time.

“I liked the way it felt,” recalled Burns, now 24.

She wasn’t thinking then about babies. But when she first became pregnant 3 1/2 years ago and tried, cold turkey, to kick what had become an addiction to heroin, the consequences were devastating: Her severe withdrawal killed the fetus.

Since then, the San Diego woman has given birth to two children. Although Burns was using cocaine while she carried her son, the boy, now 1 1/2, was not born premature or brain-damaged and did not exhibit the irritability, jitteriness or slow development that often beset such children.

Daughter Nearly Died

Last July, Burns wasn’t so lucky. She went into premature labor after injecting herself with crystal methamphetamine. Her daughter, Heather, nearly died at birth. The infant spent three weeks in intensive care and was then placed by social workers in a foster home until her father regained custody. Burns was required to enter a residential drug treatment center in Lakeside, near San Diego.

It was there, three months later, that Burns spent her first day with her daughter.

“They say when you have a baby, it’s supposed to be the happiest time in your life,” said Burns, a waif-thin bleached blonde whose angular face softens and eyes fill with tears when she talks about her children. “Neither one of them was very happy for me.”

Sherry Burns is an emblem of society’s difficulties in coping with the social, medical and legal dilemmas that arise when pregnant women abuse drugs. Such maternal drug abuse is widely believed to be increasing even as drug use is leveling off in the general population.

Difficult Questions

All across the country today law enforcement officials, public health experts and social services workers increasingly must grope with difficult questions as they try to balance the rights of mothers against the protection of children.

When and how, for instance, should society intervene to protect a substance-exposed baby from its parents? Should both the mother and child be considered victims of a disease? Or should a mother be held legally accountable--as in a recent San Diego case--for not following sound medical advice during pregnancy?

The uncertainty about how to proceed has raised concern that many infants are being sent home to drug-using environments where their health and developmental problems either are ignored or provoke abuse by parents incapable of coping with the strain of caring for damaged children.

Although maternal drug and alcohol use has begun in the last year to attract the attention of policy-makers and health-care providers, the burgeoning numbers of substance-affected pregnancies have caught the medical world and government largely unprepared.

Most health-care professionals get little training in identifying substance-abusing pregnant women or in treating addiction and pregnancy in tandem, drug experts say.

Although prevention and treatment programs clearly have helped produce healthier mothers and children, in many communities such programs are either non-existent or, at best, under-funded and oversubscribed.

National data on maternal drug use is lacking, but signs that the problem is growing are unmistakable.

Recent studies at Los Angeles hospitals have found that as many as 20% of admissions to neonatal intensive care units are associated with maternal drug use. At King-Drew Medical Center, there were 177 such cases in 1985, according to Dr. Xylina Bean, assistant professor of pediatrics. In the first nine months of this year, the count was more than 250.

Eight of every 1,000 infants born in New York City are drug addicts, according to the latest city Health Department estimate--up from 1.5 per 1,000 in the mid-1960s.

Where heroin once seemed the drug of choice among pregnant addicts, now more than 75% of drug-affected births at King Hospital and other centers are complicated by cocaine, a drug that is socially more acceptable and widely available in one form or another to both the affluent and the poor.

One recent study found that stillborns and fetal deaths occur twice as often among cocaine-exposed babies as among infants exposed to other drugs. Often, physicians say, the placenta tears away from the mother’s uterus prematurely, leaving the fetus without a life-support system.

‘Harm Cocaine Can Cause’

“Many people still do not realize the harm cocaine can cause,” said Dr. Ira Chasnoff, director of the Perinatal Center for Chemical Dependence at Northwestern University Medical School in Chicago. (In terms of magnitude, maternal alcohol use remains probably the biggest danger. Experts say about 6,000 children annually are born with fetal alcohol syndrome, which was recognized in 1973 and is characterized by distinctive facial and body malformations, mental retardation and inhibited growth. Another 36,000 infants are born each year with more subtle forms of alcohol-related damage.)

“We’re beginning to understand the magnitude of the problem,” said Vivian Weinstein, a retired associate professor of pediatrics at King Hospital and a member of Los Angeles County’s Council on Perinatal Substance Abuse. “But we haven’t figured out a system of how we are going to serve the families and the children involved.”

The experience of two communities 100 miles apart on southeastern Florida’s Gold Coast--where officials call the abuse of crack cocaine an epidemic--offers a paradigm of the difficulties.

In Vero Beach, the state prosecutor threatened this summer to press criminal child-abuse charges against a 33-year-old prostitute whose infant son was born addicted to cocaine. The planned prosecution eventually was dropped, but only because it was unclear if the woman knew her drug use could harm the unborn fetus.

‘Should Be Held Responsible’

“My feeling is that people who willfully take actions that can hurt a child should be held responsible,” State Atty. Bruce Colton said.

But in Fort Lauderdale, two hours’ drive south, Dr. Brian Udell had to fight state health officials to persuade them that maternal cocaine abuse should be recognized as a sign of potential child abuse and neglect.

The state health director rebuked Udell, director of the neonatal intensive care unit at Broward General Medical Center, for reporting to state social workers every instance of maternal cocaine use he observed. Udell fought back, drawing publicity to what he regarded as the health agency’s failure to protect newborns from the risks posed by addict mothers.

The state relented, agreeing in October to review the cases of infants born to substance abusing mothers for possible intervention. But Florida officials say they still remain unable to take action against any but the most irresponsible parents.

“We don’t have enough alternative resources,” said John Stokesberry, area director of the state Health Department. “If I had 1,000 foster homes ready to take these babies, I wouldn’t be so concerned about arresting the mother and putting her in jail.”

Efforts are under way to address such dilemmas.

Perinatal Drug Councils

Maternal drug abuse has been the subject of hearings in the last year by a congressional committee and the Los Angeles County Board of Supervisors. And four California counties, including San Diego and San Francisco, have established perinatal drug councils like the one in Los Angeles to plot tactics to combat maternal drug abuse.

In November, the March of Dimes Birth Defects Foundation launched a nationwide public awareness campaign on the dangers of drinking, smoking and drug use by pregnant women. The anti-drug act signed into law by President Reagan late in October identified pregnant women as a target group for prevention and treatment activities.

Still, the response to maternal drug abuse is in disarray in many communities. They lack the money and understanding to provide needed prevention, intervention and rehabilitation programs--from detoxification, counseling and social work for pregnant drug users to special nursery care and developmental follow-up for drug-affected newborns.

Drug abuse experts say many physicians--especially private doctors treating more affluent patients--are ignorant of the effects of maternal substance abuse. Others are unwilling to confront their patients about it, perceiving drug use as a personal choice rather than a medical matter. Many substance-using women, meanwhile, get no prenatal care at all.

The American Council for Drug Education and the Healthy Mothers/Healthy Babies Coalition, a group of 80 private and public health-related organizations, are making physicians the targets this fall of educational campaigns on maternal substance abuse. The National Institute on Drug Abuse has a contract with the American College of Obstetricians and Gynecologists to develop a medical school curriculum on the topic.

Comprehensive Care

Experience at a handful of model multidisciplinary programs--including Chasnoff’s center in Chicago and the Family Center at Thomas Jefferson University Hospital in Philadelphia--has shown that early identification of drug-using pregnant women can make a dramatic difference in the outcome of their pregnancies.

“We believe in comprehensive care, so these women are basically put back together again,” said Dr. Loretta Finnegan, director of the decade-old Philadelphia center. “An obstetrician alone can’t do it. A pediatrician alone can’t do it. A social worker alone can’t do it. Any kind of legal situation alone can’t do it. You have to put all these things together, and that’s what our program tries to do.”

Even when maternal substance abuse is detected, though, the response tends to be inconsistent. Often, nothing is done. Other times, infants like Heather Burns merely are thrust into already overburdened foster-care systems.

Like Udell, many doctors and social workers--although obliged by federal and state law to report suspected cases of child abuse and neglect--get conflicting guidance about whether to promptly refer maternal substance use to child protection agencies.

Hospital personnel in Los Angeles, San Diego and other cities are working with government officials to develop protocols for reporting drug-affected pregnancies. But for now, intervention is a scattershot affair.

In New York, for instance, the official policy of the city’s child protection agency, Special Services for Children, is to take infants from mothers identified at delivery as substance abusers, according to Joe O’Brien, an agency spokesman.

But the agency’s practice is erratic, critics say.

“It’s entirely discretionary and very chaotic, with no real attention paid to the prevention of further social disintegration,” said James Rempel, chairman of the substance abuse task force of the Public Interest Health Consortium, a coalition of New York civic groups.

“Literally thousands of children are going to their mothers with no real plan for follow-up, with no real solid preventive programs directed at the population,” said Rempel, a registered nurse who works with drug-exposed infants at a city hospital.

The government officials whose task it is to protect children and provide services to substance-abusing mothers lament that they lack the funds and programs needed to intervene in the cases that are identified.

In Los Angeles last year, a consultant’s study suggested that the problem of maternal drug abuse in the county was bigger than officials realized. Then spending was boosted from $600,000 to nearly $895,000 on services for chemically dependent pregnant women, according to the county drug abuse office.

Yet women in Los Angeles County still must wait up to six months for one of 44 slots at the two residential drug treatment programs that allow them to live with their children, according to Irma Strantz, director of the county office.

Residential Treatment Sought

“We desperately need to expand our prevention and education program in this regard,” Strantz said. “We need to expand our treatment system to fund more residential beds for pregnant addicted women who are not amenable to treatment on an outpatient basis.”

Many physicians and social service professionals complain that even as prevention and treatment are getting short shrift, public debate and government action are turning to harsh talk of criminalization and punishment as society’s best response to drug-damaged babies.

The concern is spurred by cases like that of Pamela Rae Stewart, 27, an El Cajon woman facing a misdemeanor criminal charge of contributing to her newborn son’s death by ignoring her doctor’s medical advice during pregnancy.

According to San Diego County prosecutors, a doctor ordered Stewart to rest in bed and halt illicit drug use and intercourse when she developed unusual contractions during her eighth month of pregnancy last November. A few days later, according to police and coroner’s reports, she used methamphetamine and had intercourse with her husband, triggering heavy bleeding and the premature delivery of her son, Travis Monson, who was severely brain damaged.

Travis died six weeks later, and Stewart was charged with failing to provide medical care to the child. Prosecutors now say the alleged drug use is a minor aspect of the case; studies have shown no demonstrable link between maternal amphetamine use and brain damage in newborns. Still, health professionals are concerned about the precedents it could set for other substance-abusing mothers.

‘Into the Closet’

“All you’re going to do is drive these women who are substance abusers deeper into the closet,” Chasnoff said.

“These people are out of control, really,” added Dr. Ivan Frantz, director of the neonatal intensive care unit at New England Medical Center in Boston. “The threat of criminal prosecution is not likely to change what they’re able to do.”

Other physicians say a few prosecutions could help gain the attention of women who otherwise have not been reached by warnings of the dangers of substance use during pregnancy. But even supporters see only a minor role for such cases in the campaign against maternal drug use.

“I would think some thoughtful support of it as a possible weapon to be used by enforcement authorities in selective instances sounds right,” said Dr. John Larsen, a professor at George Washington University Medical Center in Washington.

“As a broad policy, to go out and go after everyone--no, I don’t think that’s going to be particularly helpful,” Larsen said. “I don’t think it’s going to cure the society of drug-abusing people.”