A few weeks after giving birth to her first child, a 32-year-old Tustin advertising executive wondered why she could not comfort the inconsolably cranky newborn. Her pediatrician referred her to Tim Healy, a pediatric physical therapist who often treats drug babies.
After coming to trust that Healy would not report her, she told him what she had revealed to neither her doctor nor the hospital where she had given birth: She had snorted cocaine four times recreationally during her pregnancy. Now she wondered whether that might have caused the problem.
The answer, Healy replied, was yes.
The story illustrates the changing profile of the pregnant drug user, which authorities believe has resulted in under-reporting of drug-exposed babies.
They said that doctors in affluent areas such as Orange County are unwilling to report cocaine use among their white, middle-class patients.
"In the patient who looks like a real quality person, you tend not to ask," said Roger Schlesinger, president of the Orange County Obstetrical and Gynecological Society. "Maybe there's a bit of denial; they don't believe this very nice lady could be a weekend cocaine user."
Most physicians were not trained in an era of heavy drug use, said Judy Howard, a pediatrician and researcher at the UCLA School of Medicine. "They're very ignorant about middle- and upper-middle-class substance abuse."
According to a nationwide survey of hospitals by the Chicago-based National Assn. for Perinatal Addiction Research and Education (NAPARE), 11% of all newborns have been affected by their mothers' use of cocaine during pregnancy, and the statistics cut through all levels of income and education.
"It's surprising and shocking to people who thought we just didn't have this problem in beautiful downtown Camelot," said Dr. Willard Blankenship, director of neonatology at Mission Hospital Regional Medical Center in Mission Viejo. The hospital, which serves the largely affluent South County, has identified more drug babies in the past year than in the previous five years, he said.
A survey of hospital medical directors and nursing managers conducted last summer by a group of public and private children's organizations in Orange County concluded that of an estimated 1,248 Orange County children born exposed to drugs each year, only a quarter are reported to authorities. The estimates were arrived at through interviews with hospital administrators and nursing supervisors who observe newborns firsthand.
Of the 24 Orange County hospitals surveyed, only 11 have written policies regarding urine toxicology tests on mothers or babies, while the rest rely on the individual doctors, said Mary Harris, program analyst for the county Social Services Agency.
Most reserve testing for only the most obvious cases, she said.
Without early identification of a drug-using mother and a drug-exposed infant, bonding between mother and child is often impaired.
"The problem with addiction is: Parents have one priority and that is to their addiction," Howard said. "They are only intermittently available to the baby. And if there's anyone in a dependent state, it's a baby.
"You're setting up a situation for neglect and overt abuse," Howard said.
Mission Hospital tests for drugs only upon noticeable signs and symptoms and does not routinely test because drug testing has been considered an invasion of privacy, Blankenship said.
Moreover, he said a doctor-patient relationship might be destroyed if a patient receives a bill for a drug test after denying using drugs.
However, recent court decisions have appeared to strengthen the position of hospitals that report mothers to child-abuse authorities if their newborns test positive to drugs.
Last month, the state Supreme Court upheld an Oceanside hospital that had reported a mother to child-protection authorities after obtaining positive tests for amphetamines and opiates on both the mother and the newborn son. As a result, the Juvenile Court took custody of the child.
While the mother had complained of an invasion of privacy, the court stated that prenatal use of dangerous drugs constitutes evidence of future child neglect.
Schlesinger said he routinely tests pregnant women who come to an emergency room to deliver with no prenatal care and also those in his Fullerton practice who admit using drugs.
He said he asks all his patients "in a casual, nonjudgmental fashion" whether they are using cocaine, alcohol or marijuana.
"I'm often surprised when talking to people who appear to be nice, stable folks," he said, "how many positive responses there are to using street drugs.
While cocaine use among pregnant women may be significantly under-reported, Schlesinger believes it has not caused much of a problem.
"Unless someone is really a pretty heavy user, you don't see problems in the babies," he said. Others disagree.
A hit of cocaine causes a rise in the mother's blood pressure, constricting the blood flow to the fetus and putting it at risk of stroke or inhibited development, said Pat O'Keefe, director of communications for the Chicago-based research association.
Cocaine also causes the onset of contractions, therefore promoting premature births with all their attendant problems, she said.