Recently, Reuters reporters Duff Wilson and John Schiffman, working in partnership with NBC News, published an extensive investigational report documenting the deaths of 110 babies who were born to mothers who used opioids during their pregnancies.
Doctors, nurses and other hospital personnel knew that these infants were born suffering from Neonatal Abstinence Syndrome (NAS) and yet, despite a requirement I wrote into federal law in 2003, either they failed to notify local Child Protective Service agencies or the agencies failed to protect the babies. Because of these failures, social workers did not create safe plans of care for these children as the law requires. In the absence of that intervention, these newborns died, suffocated under their passed out mothers’ bodies, drowned in bathtubs and, in one instance, after being put into a washing machine with a load of dirty laundry. None of these children needed to have suffered and died.
{mosads}In the 1970s I was a caseworker at a county Children and Youth Social Services Agency. I saw too many abused and neglected children. I removed them from the custody of their parents when I had to and then reunited them when I could. In 1980 I was elected to the Pennsylvania Legislature, where I founded the Children’s Caucus and worked on a variety of matters critical to youngsters. Among the issues that arose in that decade was how to respond to the fact that an epidemic of crack cocaine abuse was resulting in thousands of babies being born addicted.
State and federal legislators were offering proposals that ranged from locking up the pregnant addicts so they couldn’t get access to the drug to deeming the use of drugs during pregnancy as child abuse, to automatically removing the newborns from the care and custody of their mothers and charging the mothers with a drug-related crime.
My previous experience as a caseworker led me to propose a less punitive approach. I suggested that when healthcare workers determine a newborn to be suffering from NAS or Fetal Alcohol Syndrome (FAS), they would be required to report that fact to the local Child Protective Service agency. They agency would, in turn, be required to meet with the mother and to create a safe plan of care for her baby. Preferably, that plan would have the child leaving the hospital in the mother’s care and custody following the determination that she could provide a secure home, the mother volunteering to receive addiction counseling and regular follow up visits by caseworkers and, if appropriate, parenting counselors. This approach was intended to be compassionate to the mother and protective of the child.
While I was unable to pass this legislation in Pennsylvania in the ’80s, I was elected to Congress in 1992 and was successful in 2003 in placing these provisions into federal law. Now the drug epidemic has moved to heroin and prescription opioid abuse. In 2000, approximately 1 out of every 1,000 babies born in America suffered from prenatal exposure to addictive prescription or illegal drugs. By 2012, babies born in withdrawal accounted for nearly 6 out of every 1,000 births. In other words, every 25 minutes a baby was born addicted to drugs — 30,000 per year.
A baby born with NAS can cry excessively, experience tremors or seizures and suffer from a low birth weight that can be further complicated by difficulty eating. These babies have complex medical complications that require extended and expensive treatment in a hospital’s neonatal intensive care unit. Recent research indicates that after the NAS baby is discharged from the hospital, they are 2.5 times more likely to require another hospital admission within a month.
The Reuters investigation uncovered the bitter reality that in far too many cases, the law Congress passed a dozen years ago is being ignored and hundreds of babies across the nation are dying as a result. And certainly thousands more are suffering less-than-fatal physical and mental injuries.
Whose fault is this? There is plenty of blame to go around. The federal Department of Health and Human Services has failed to police this state requirement. State human service agencies have failed to uphold their obligations to insure that hospitals report these cases. Local agencies have not always done their part and doctors, nurses and hospital administrators have failed to fulfill their roles as the first points of contact. This needs to change immediately.
During the congressional debate in the early 2000s and now, there remains a troubling and utterly false narrative that protecting substance-exposed babies is a direct or indirect way of stigmatizing and punishing mothers. To the contrary, the development of a plan of safe care is intended to be the best way to help these addicted mothers get off drugs; prepare safe homes for their precious newborns; avail themselves of supportive services, including evidence-based home visiting; and avoid the worst outcome of all — the death of their babies at the own hands.
Let’s stop sending substance-exposed babies to unsafe environments to die because we divided ourselves into two camps — advocate for the mother or advocate for the baby. Let’s give more addicted mothers the opportunity to get the help and counseling and services they need so they can be successful and healthy moms with thriving and healthy babies.
Greenwood served in the House from 1993 to 2005. He is president and CEO of the Biotechnology Innovation Organization.