Pregnant Drug Addicts, Babies Jam Agencies

Sarah got her first taste of heroin at age 14, when an uncle fashioned a tourniquet around her skinny arm and injected her.

She was quickly hooked, and by the time she turned 18, she was pregnant, too. But motherhood scarcely interrupted her addiction then, or the next time she got pregnant. Or the next time.

“When I was pregnant, I had to use double,” she explained, “because a lot of it went to the baby. . . . I would say, ‘I don’t want to use.’ Then I would stick the needle in my arm and say, ‘God help me.’ ”

Now 30, Sarah is an Orange County mother of three daughters, ages 1, 2 and 11. One, born while Sarah was in a methadone-treatment program, entered the world addicted to the heroin substitute. And although Sarah, who spoke on condition that her real name not be used, insisted that the other 2 children were not affected by her drug use, she recalled that the 2-year-old “for the first 4 or 5 months . . . would shake real bad out of nowhere.”

There are many women like Sarah in Orange County, and many more children, according to county health and child welfare officials. Their numbers are growing rapidly, but the social network is not. Two county agencies that assist pregnant addicts and protect their children are overloaded, constrained by a county hiring freeze and, increasingly, unable to meet the burgeoning need.

“The problem is enormous and getting worse,” said Sylvia Wall, deputy director of child care for the Orange County Social Services Agency. “There are hundreds of mothers out there, and for every child we come in contact with, there are probably two or three more that we never hear about.”

Sarah is now in the Orange County Health Care Agency’s Perinatal Treatment Program, an intensive regimen of counseling and drug screening that may enable her to regain custody of her children. The model program, started with 18 women in 1985, has grown to 170 women, with a waiting list of 60 to 80 more.

Her daughters are in foster care, as they have been off and on throughout their lives. Children of substance abusers make up 62% of all newborns who are referred to the social services agency, and 30% of the agency’s caseload of 2,200 youngsters. Meanwhile, only 38 of the county’s 400 foster-care slots are equipped for the special problems of drug babies, who often suffer physical and neurological defects.

No one knows how many drug-exposed babies fall through the cracks because they show no obvious signs of withdrawal. But a case review of families involved in just two county programs found that 1,662 children under the age of 3 had likely been exposed to drugs during pregnancy but had not been detected previously. The study, presented in January by county health educator Marian Henry, recommends expansion of prenatal care and drug-treatment services.

“It’s at a crisis stage for us, because we are always struggling to find foster homes for these babies,” said Mary Harris, program analyst for the social services agency. “We never have the luxury of too many foster homes.”

Glenn and Jan Allen measure the distance they dare stray from their 1-year-old foster son in seconds, not feet or yards.

When he naps, Billy’s breathing is monitored by an electronic device that sounds a piercing alarm if he does not draw a breath for 20 seconds. The Allens, both nurses, must be close enough that they can quickly reach Billy and awaken him or perform cardiopulmonary resuscitation.

“You can’t ever be more than 10 seconds from the baby, because by the time you get to him, he’s already been without oxygen for 30 seconds,” Jan Allen said. “Sometimes, the monitor will go off 150 to 200 times a night, and then there is nothing for a month.”

The Allens, who have a 15-year-old daughter, have opened their San Juan Capistrano home to 105 foster children in less than 10 years. Like Billy, who was born in a hotel room to a cocaine addict, most of the children were exposed to street drugs in the womb. And, like Billy, many cry inconsolably, suffer bouts of jitters, lethargy and apnea, a neurological defect that can cause them to suddenly stop breathing.

Withdrawal has been different with each child, according to Glenn Allen.

“Some of the kids have gone through intense periods of pain and aversion to touch or any stimulation. Then they seem OK. Other kids go through withdrawal that seems to go on forever and ever. Developmentally, these children are usually delayed; a year or more behind other kids in some areas. They might catch up, if they are fortunate and get the right care.”

Billy is tethered to a portable apnea monitor that records his breathing whenever the Allens bring him on an outing: he could fall asleep in a car seat or a shopping cart and suffocate. Their home is outfitted like a neo-natal nursery, with high-tech gadgetry and dim lights to reduce environmental stimulation for hypersensitive infants. Care of such infants is so demanding that the couple have formed a High Risk Infant Team to train and support other foster parents.

“I feel angry at the mothers,” Jan Allen said. “I think they should be forced to go into drug treatment programs. We need more treatment programs to help the borderline cases keep their kids. But sometimes, you have four or five addicted kids from the same mother who is always on drugs. That’s a hopeless case.”

Billy’s mother has visited him once in the 8 months he has spent with the Allens. “She seemed like a nice girl,” Glenn Allen said. “She was trying to get it together and for a while she was drug-free. But then she went back to drugs and we haven’t heard from her since.”

Billy, whose name has been changed to conceal his identity, will be the Allen’s last foster child. The couple is about to complete the adoption of a 3-year-old boy whose mother and grandmother were heroin addicts. Then they will concentrate on their newly expanded family for a while.

“These children need a homelike environment, but not at the cost of burnout for a foster family,” Jan Allen said. “It can be very stressful. You have to give yourself space, time to keep your relationship alive with your husband and the rest of your family. You can’t try to save the world.”

There isn’t much public sympathy for drug addicts, especially women who are addicts, officials of the Orange County Health Care Agency realize.

“There is a pervasive attitude that these women are criminals and what they are doing is a crime,” said Bill Edelman, manager of the agency’s drug program. “But they are producing children, and unless we get involved, we won’t change their lives.”

The women who participate in the health care agency’s Perinatal Treatment Program all are mothers, ages 18 to around 35. Some come voluntarily, but more often they are ordered to take part by a judge or a social worker as a condition to keeping or regaining custody of their children.

No residential treatment is available for drug-addicted mothers in Orange County, but the outpatient perinatal program includes some of the hard-nosed structure found in inpatient programs. Clients are required to attend group and individual therapy sessions and to undergo drug testing twice a week. If their drug tests indicate recent use, they risk expulsion. If they are late for appointments, they are counted absent.

For many, it is the first time in their lives that they have had to follow strict rules. Their lives have been chaotic and often violent, without the daily discipline of school or employment. Most of the women were victims of their environments long before they victimized a new generation through drugs.

“What society needs to understand is that these women do drugs for a reason,” said Shoni Welsh, chief of the perinatal program, which operates on a $400,000 annual budget. “Drugs help them deal with their lives. They have very transient, unstable life styles. Without the drugs, it would be more difficult to deal with issues like incest, abandonment, abuse.”

Sarah is typical of the women being treated by the county. Her father and all nine siblings were addicted to heroin, and family arguments were occasionally punctuated by gunfire. In her out-of-control household, drugs were a part of “normal” life. Even as an adult, she is more comfortable around fellow drug addicts than people who don’t use drugs.

Sarah twists her long, dark hair around a finger as she talks. Her voice is soft and flat as she describes the need for drugs that led her into burglary, prostitution and theft. “I started with heroin; I guess that’s why I never liked pot,” she said. “I was the youngest, and every time I came home it (heroin) would be there. I didn’t know where else to go. After a while, I did what I had to do to pay for my drugs.”

Sarah said she realized that she was hooked around age 17. Because drug use caused her to stop menstruating and to feel sick most of the time when she wasn’t high, she said she did not realize that she was pregnant until she was 7 months along.

“I wanted to stop. When you’re hooked, you hurt, you vomit and you cry. . . . How can people think a drug addict don’t care (about her children). Get a drug addict when they are clean and sober and they’ll tell you how much they care.”

Even with help, the success of the women in the perinatal program at staying off drugs is not good, Welsh said. “Over 50% of our women do get their children back,” she said, pausing for a long moment before adding, “but there is a big relapse rate.”

Sarah began “slipping” during recent weeks, Welsh said. She tested positive a few times in succession, perhaps as a result of a family crisis. Finally, Sarah entered an inpatient detoxification and drug-counseling program, where she is still being treated.

“She went into detox voluntarily,” Welsh said. “That’s a good sign--it shows motivation.”

DRUG BABIES

Infants born to addicts raise fetal rights issue. Part I, Page 1.