THE UNBORN ADDICTS

Entering the world with a heroin habit, the babies suffer the agonies of
drug withdrawal. Ali Lawlor reports on the hospitals trying to help
pregnant drug-users and their unborn children.

A HIGH-pitched scream can be heard in the hallway next to a hospital ward
for new-born babies.

The scream of enduring pain continues almost constantly for up to a
fortnight, the vocal strength of the baby's cries defying the size of the
premature boy who is barely the size of a Coke bottle.

Inside his humidicrib, he has been sweating, shaking, jerking, vomiting,
sometimes sleeping for only an hour a day.

The baby is a drug addict - a habit he acquired in his mother's womb.

His cries of agony are part of his withdrawal symptoms.

Each year in Queensland, hundreds of babies are born addicted to drugs such
as amphetamines ("speed"), heroin, methadone and marijuana.

They vomit, have seizures, diarrhoea and, in rare cases, are born deformed.

Although there is no conclusive research on the long-term outcomes for
drug-dependent babies, doctors warn mothers that there is increased risk of
premature labour, stillbirths, physical malformations and sudden infant
death.

But some women don't pay any heed and continue throughout pregnancy taking
illicit drugs that will give their unborn child such a traumatic start in
life.

Many are unaware of the effects of some drugs on their babies, and many
addicted mothers-to-be are too afraid to seek professional help.

Anne's baby, Nicholas, was born last month. He weighed just one kilo and
withdrew from methadone for nine days - jerking, sweating and suffering
diarrhoea.

Anne, 38, from central Queensland, has been a drug-user for more than 20 years.

She says that she had an overwhelming feeling of guilt and worry knowing
her child would come into the world withdrawing from methadone.

"I used to feel very guilty that this baby is going to come into the world
with a habit," she says. "All you are thinking is that this tiny person is
coming into the world and is starting off with a handicap straight away
because he is going to have a habit straight away. It still worries me even
now that he's off it."

She had a hard pregnancy, bleeding every week and thinking daily "I am
going to lose him".

"The baby is an absolute miracle," she says. "I was never supposed to have
children due to my past and age, so I didn't find out till I was 3 1/2
months.

"When you're on the methadone, if you are trying to fall pregnant they
reduce your intake before the baby is born, but in my case, because it was
3 1/2 months, they couldn't just start reducing me because it would cause a
miscarriage.

"It was a big concern to me and there wasn't anyone up there to give me
answers, and because they couldn't reduce me I had to stay on that dose for
the whole pregnancy."

Anne was sent to Brisbane Royal Women's Hospital where she received the
expert help she needed.

But she says there are many women in similar situations who are too ashamed
or frightened to seek help.

Royal Women's Hospital neo-natal specialist Dr Tim Donovan says it is vital
that women who are drug-users are aware of increased risk during and after
pregnancy.

"There are concerns that marijuana could have growth effects as we've seen
an increased incidence of gastroschisis or a hole in the front of the
baby's belly," Donovan says.

Illicit drugs were of most concern and the new designer drugs - as yet
untested in this field - also could be a big problem.

"With all these new designer drugs, it's very hard to say what the effect
on the baby will be," he says.

"At least with cocaine, we can say to the mother, 'look, there's a chance
the baby will have a stroke, be deformed or a chance that you will deliver
your baby early'. The newer drugs, however, are not tested."

Drug-users also bring other dangers to their unborn children.

"Hepatitis C and B are also an issue, with a high rate of infection in
drug-users, and there is a very real risk of the baby getting either," says
Donovan,

An 11-year study at Westmead Hospital in Sydney found the rate of serious
malformations in drug-dependant babies ran at two to three times the normal
rate.

Of 478 mothers involved in the study, 26 had babies which died or had major
malformations; seven cases had a cleft lip (10 times the normal rate); and
the incidence of sudden infant death syndrome was five (five times the
expected rate).

"It could compare to Queensland," says Donovan. "From our indications and
data at this hospital, the numbers would easily be as much over an 11-year
period."

At the Royal Women's, about 35 babies a year have to be weaned off illicit
drugs the moment they are born.

More than 70 mothers have been treated there since June.

The Mater Mothers Hospital cares annually for about 35 babies who have to
be weaned off methadone and for up to 20 more who suffer withdrawal from
other illicit substances, particularly amphetamines.

Mater director of neonatology Dr David Tudehope says, however, that the
mothers the hospital sees each year are just the tip of the iceberg.

"The overall problem in the state has escalated undoubtedly, but the
numbers in this hospital have been relatively static because there has been
a greater acceptance of these patients at regional hospitals," he says.

And, he says, there is the chance that with faster discharge times for
patients, some mothers and babies that need help may slip through the net.

"There aren't a lot of women going home with babies without help, but the
chances of it occurring now - with 75 percent to 80 percent of our mums
being discharged within 48 hours - are greater than what it used to be when
they were in five days," he says.

"Often, withdrawal doesn't manifest itself till the third or fourth day and
it's quite easy to conceal withdrawal in the post-natal ward. But if you do
take your baby home without help, you're in for a really hard time."

Tudehope says that, in his view, there may not be long-term repercussions
for a child as a direct result of being born addicted. "I'm not convinced
there is a long-term deleterious effect from heroin or methadone in-utero."

But he adds: "What's more important is the environmental influence after
discharge, and we don't know an awful lot about the environment.

"A lot of these families are very nurturing but a lot are not - a
drug-addicted lifestyle is very chaotic."

Mater social worker Meredith Kenny estimates that of the drug-using
pregnant women who attend the hospital, only half receive advice about the
risks.

"I think when social work is mentioned, they automatically associate it as
being welfare or Family Services," she says, "and a great fear for anyone
who is using a substance is that their kids might be removed from them. But
we are here to support them and provide information."

It is vital that women are told before the birth about the possible
scenarios. "It's important that the women are here ante- XXXX taken into
care and if they are it is usually a temporary order so that parents are
able to change some aspects of their lifestyle and be in a better position
to care for the baby."

It also is important that the mothers become stable with their drug habits
and seek follow-up care after the baby is born, says Kenny.

"If they are a regular heroin user, then they are probably better to be
stabilised on methadone because with street heroin you never know what it's
cut with. If their supplier disappears, they risk withdrawing and the baby
risks withdrawing and that could cause a miscarriage."

The key, says Alex Whiteman of needle exchange centre Quiver, is to
convince women who are pregnant and using drugs that they can get
nonjudgmental medical help.

"There is a fair degree of guilt or fear about what they have done, or if
this is going to affect their babies. We're not seeing women who are
recklessly endangering their children; it's people who discover that in
their second or third missed period that they are pregnant.

"I don't think there has been any help whatsoever for them," he says. "Up
to now, they have been left at the mercy of an individual medical
practitioner. It's one of the reasons that hospitals have taken this task -
because women drug-users present very late."

Both hospitals acknowledge that, in the past, care for such women has been
fragmented, but say they have this year tried to resolve the situation,
setting up specialist teams to help deal with these families.

Mater Mothers' project officer Kate Ramsay said the Federal Government had
approved a $320,000 project over four years to enhance the services to
mothers and babies who had drug dependencies.

"One of the main components of the project is education, because when
health-care professionals are faced with people who have been using drugs
as part of their lifestyles, they are facing a whole lot of challenges and
it is possible they may make a judgment XXXX likely they are to disclose
and seek long-term help, and that's what we are aiming for."

It is important, she says, that the public health-care system acknowledges
a need for appropriate and unique health-care services for this group of
women.

"If that means providing a service outside this hospital, well that's what
we do, so that women who don't attend the hospital for routine check-ups
have accessible treatment," she says.

Marie, 28, was using heroin until she discovered she was three months
pregnant and decided to stabiise on methadone.

Although she had her baby three weeks ago she is still receiving support
from the Mater Mother's Hospital, not only for her baby but to treat the
problems behind her drug use.

"I think there is a big stigma attached to drug use and one of the main
things you experience when you have a habit is society's pressure and guilt
and it puts you through hell," she says.

"But there is help available and the most important thing is that there is
no discrimination given to you, you are not made to feel bad of the choices
you have made and you are given a pat on the back for allowing the nurses
and doctors to give you and your baby the best treatment they can.

"The baby makes you think more clearly about priorities when you realise
that you actually care. I have been given access to social workers and
psychologists, people that not only help the symptoms of drug abuse but the
problems that caused it - it's long-term help for me and my baby."

Tudehope says there have been cynics who have questioned the support
currently given to pregnant drug-users.

"I know there have been cynics who have said 'how do you know that you have
actually done some good?'

"But during pregnancy their conscience is smitten and we see it as a window
of opportunity for them to change from a chaotic lifestyle to a more
ordered lifestyle.

Checked-by: Joel W. Johnson