DRUGS BOND MOTHER, CHILD IN ILLNESS

Families Find That Charging Abuse Is Difficult Before A Baby's Birth, But A
New Law Offers Hope

Destiny Smith arrived in this world with a hole in her heart.

Born three months early, the 2-pound girl with wispy brown hair had another
characteristic that shaped her life:

Cocaine in her bloodstream.

Her twin sister, Macayla, did too. Macayla weighed 4 ounces more, and had a
better chance at the life the twins began on March 10.

Seeing the twins struggle to live, two grandmothers - Sheri LaBarbera and
Mary David - have spent hours sitting in hospital intensive care units
asking a question they're at a loss to answer:

What can be done to keep babies from being born addicted to drugs or alcohol?

"These children are victims," said LaBarbera. "If nothing is done, it will
just keep happening."

Policy-makers, social workers and medical experts across the country have
wrestled with the same question over the past decade, as the phenomenon of
drug- addicted babies has taken root in hospital maternity wards.

The questions invariably raise all the same vexing issues:

When does a fetus become a person? How do you balance privacy and autonomy
of the mother with the protection of the child? Will babies do better if
the mother is jailed and separated from the child, or if the mother gets
treatment and help with parenting?

For years, there was little that child-abuse investigators could do when
they got a call from a relative or hospital worker telling them a child was
born addicted to drugs or alcohol. Legally, abuse or neglect can't occur
until after a child is born.

But last July, that changed when a Virginia law went into effect. The law
requires doctors to call Child Protective Services - the agency in charge
of investigating child abuse - when a newborn tests positive for controlled
substances, or is born with a condition caused by exposure to drugs or
alcohol in the womb.

The Virginia law has not yet produced much of an increase in substantiated
cases of abuse, because to consider a complaint valid, an investigator
still must find abuse or neglect after the child is born.

Local CPS investigators say doctors have referred 85 cases to them since
the law took effect. Of those, fewer than five resulted in substantiated
child- abuse findings, which can give judges and social workers power to
remove children from their parents.

But the law has given abuse investigators a small window of opportunity to
ask questions about where the babies will go after release from the hospital.

"We are getting our foot in the door earlier," said Jill Baker, supervisor
of Norfolk Child Protective Services. "We have more leverage to get
preliminary protective orders, or to require parents to complete substance
abuse counseling."

The law, however, seems woefully inadequate to relatives struggling to care
for children born exposed to drugs.

Forty-year-old Sheri LaBarbera is one of them.

Her 22-year-old daughter, Justine LaBarbera, had her first child, Amber,
four years ago. Justine came home with the baby to live with her parents in
their Virginia Beach home. Within a few months, Sheri suspected her
daughter was using drugs. Justine would take the baby with her in the
middle of the night and not come home until the early-morning hours.

Finally, Sheri followed her daughter to a neighborhood where she believes
she witnessed her daughter buying crack. The next day Sheri went to court
to get custody of her granddaughter.

Justine did not fight for custody.

A few years later, Sheri found out Justine was pregnant with a second
child. LaBarbera knew her daughter was still using drugs, so she called
Child Protective Services. They told her there was nothing they could do
for an unborn child.

The day the second baby, Brittany, was born in November 1997, Sheri again
called Child Protective Services, to tell them the baby was born addicted
to cocaine. Again, they said there was nothing they could do. Giving birth
to a drug-exposed child is not illegal. "I said, `You'd let a brand new
baby go home with someone on crack?' " Sheri recalled.

Together with a hospital social worker, however, Sheri found out the house
trailer her daughter was taking the baby to had no heat or running water.
Based on that information, Child Protective Services got involved, and
Sheri and her husband, Tommy, eventually received custody of the baby.

They're now caring for two grandchildren, 4-year-old Amber, and
16-month-old Brittany.

Last September, Sheri received a call from the hospital that Justine was
being treated for a cocaine overdose. She went to pick up her daughter, and
as they were leaving, the doctor mentioned Justine was pregnant.

"I'm like, `Oh, God, no, please,' " Sheri said.

Sheri tried to talk her daughter into getting treatment, as she had many
times in the past. "She was in denial forever," Sheri said. The LaBarberas
refused to let Justine live at home as long as she was using drugs.

Justine moved into a Suffolk apartment with Jason Smith, the father of the
twin babies who would arrive the next March. He, too, was horrified his
girlfriend was using drugs while pregnant.

"Every night of the week she was using drugs," said Smith, who broke up
with Justine before the babies were born. He said he called the police, who
told them there was nothing they could do.

"If you do drugs when you're pregnant, it's like kidnapping and malicious
wounding, or even manslaughter or murder," he said.

Both Sheri and Smith said Justine tried to get drug treatment, and even
went to the Western Tidewater Community Services Board with a packed bag.
But the facility she wanted to enter - the Green Street Substance Abuse
Program in Portsmouth - was full. Justine would have to wait for one of its
14 female-designated beds to open.

She was not inclined to do so.

On March 10, Sheri received a phone call that Justine was in labor at
Virginia Beach General Hospital.

"I knew it was too early," Sheri said. She rushed to the maternity ward.
While other happy visitors arrived with flowers and gifts, Sheri walked
through swinging doors with a sense of dread. A single thought ran through
her mind:

"Another one."

Only it was another two.

The cost of treating drug-exposed children like Destiny and Macayla can be
tremendous.

Pregnant women on drugs often give birth prematurely to babies whose lungs,
hearts and other organs haven't had time to develop. A drug habit

also can mean the mother is not eating right, sleeping well or taking
vitamins, which also affect the health of the baby.

Long-term effects of drug exposure in the womb are harder to nail down. By
itself, cocaine exposure may not have the devastating effects originally
feared when the epidemic was first noted in the mid-1980s.

The challenge is distinguishing what happened in the womb from what unfolds
after the baby goes home.

"Most kids go back to a not-so-great environment, and you can't tell
whether they have health problems because they're propped up in front of a
TV set or because they were exposed to drugs in utero," said Dr. Jamil
Khan, medical director of the newborn intensive care unit at Children's
Hospital of The King's Daughters.

Some kids do fine; others have attention deficit problems and developmental
delays that affect them for life.

Hospitals often link up mothers of drug-exposed babies with home- visiting
public health nurses, in hopes of making sure the babies are safe. That's
also a way of monitoring whether abuse is occurring at home.

"There were situations where babies were being taken to houses that were
dirty, where there were drugs all over the place, where there was
prostitution going on, and that's not a place for a baby," Khan said.

Getting CPS involved from the start - through the law that went into effect
last July - adds a layer of seriousness, even if the investigation closes
with no action. "It lets mothers know there's a potential problem as far as
custody of the child goes," said Mary Barholm, case manager of the special
care nursery at Sentara Norfolk General Hospital.

The legislator who proposed the law, however, had something tougher in mind.

Del. William Howell, R-Fredricksburg, first proposed the law after a
juvenile judge told him nothing could be done when babies were exposed to
drugs and alcohol in the womb.

The law he proposed got watered down with a long list of limitations:

The reporting must be done within seven days of a child's birth, and the
blood or urine test must be conducted within 48 hours of the birth. Mothers
who sought substance abuse treatment while they were pregnant cannot be
found guilty of abuse, or named in the state's abuser list.

Khan said he would have had misgivings about a law with a more punitive
bent. "If you criminalize it, women will stop getting prenatal care," he said.

The law seems to be having a "moderate" and positive effect, he said. But
it doesn't address all the risks that babies are exposed to in the womb.
For instance, he said, babies whose mothers smoke cigarettes while pregnant
also are born in poorer health, yet that is not addressed.

"It's a political law rather than a medical one," Khan said.

For Sheri, the law meant she wouldn't need to call child abuse
investigators after the twins' birth. The hospital informed child abuse
investigators, and an investigation followed, according to Sheri and the
babies' father.

The twins' paternal grandmother, Mary David, received custody of the
children a few weeks after they were born.

Another law that took effect at the same time as Howell's law requires
hospitals to refer the mothers of drug-exposed newborns to their local
Community Services Boards for treatment. That's a law that some substance
abuse professionals believe may have more impact.

Tom Diklich, substance abuse service administrator for the Portsmouth
Department of Behavioral Health Care Services, said that the city has
received 22 referrals from hospitals since the referral law went into
effect last July.

"We've got more pregnant females and more females with dependent children
than we've ever seen before," Diklich said. "Is it everyone out there who
needs it? No. We can do better. The costs to the individual, the children
and the community are huge."

And while Justine and her family say she tried to get treatment, Diklich
said that local agencies usually give priority to pregnant women. Even when
an inpatient facility like Green Street is full, substance abuse officials
find other ways to serve pregnant women.

Justine LaBarbera's curly, long brown hair tumbled over her orange jail
coveralls as she sat in Virginia Beach Jail three weeks after her twins
were born. Her face was pale, her body thin. She's serving time for charges
that are not directly related to her use of drugs while pregnant.

She said she started using drugs after the birth of her first child. The
father of the child left her soon after Amber's birth. "I was such an
emotional wreck. When I was high, it cured my depression, it made me not
think about my problems."

When her parents told her she couldn't live with them unless she stopped
using drugs, she fell even deeper into the drug culture. She was often
homeless, and would walk from one Virginia Beach motel to another. She
tried to make money however she could to support her habit, which is how
she ended up in jail on charges her mother asks not to be published.

"My low self-esteem put me in that lifestyle," she said. "I was on the
street and I lived the street lifestyle. I got beat up really bad. The only
place to stay was where people used."

She didn't have any prenatal care, and didn't even realize she was having
twins until she went into labor March 10. But she did know one thing that day:

"I knew they weren't ready."

She had an emergency Caesarean section and didn't see the babies for two
days. She remembers her first glance at her daughters. "It was horrifying,"
she said. "They didn't even look like babies. They were so skinny, frail,
small, helpless."

She said she'd like to get into a drug treatment program after she's
released from prison, but realizes she's not able to care for her children
now.

"I don't think I could do it at this point," she said. "I don't trust myself."

Thirty-three days after Destiny was born, the two grandmothers and the
father received calls from Children's Hospital of The King's Daughters,
where Destiny had been transferred for open-heart surgery. Destiny was
dying. They needed to come hold the baby one more time.

When Sheri arrived about 9:30 a.m. April 12, the baby had just drawn her
last breath.

Justine screamed when the jail chaplain told her Destiny had died.

Nineteen people came to Destiny's funeral last Sunday. Justine sat alone -
except for the sheriff's deputy - in the last row.

Few could see her during the service, but most could hear Justine's sobs
intermingled with the clinking of her handcuffs and leg shackles.

Sheri told the small gathering about how she believes Destiny shielded her
sister in the womb, and how the baby will continue to watch over her twin
from heaven.

The grandmother believes Destiny's death also can serve to raise awareness
of the problem of drug-exposed babies. She hopes for a law that would force
pregnant, drug-using women into rehabilitation, which she thinks would lead
to more rehab programs for pregnant women. She keeps referring to her idea
as "Destiny's Law," even though she's not exactly sure how to make it happen.

Still, she clings to the idea, in memory of a child born to die.

Macayla, meanwhile, gains weight, gram by gram, at Virginia Beach General
Hospital.

Her tissue-thin eyelids fluttered open, and she turned her head in the
direction of her grandmother calling out to her a few days after Destiny died.

"Macayla?" Sheri said as the baby's tiny hand stretched out against Sheri's
index finger. "Isn't she little?" she asked. "She doesn't know what's ahead
of her. She doesn't know anything yet."

But someday she'll know about the twin named Destiny.