THE BABIES BORN TO JUNKIES

What should we do about parents hooked on heroin? Should they be allowed to
raise their own children? REBECCA McQUILLAN investigates the controversial
policy of leaving babies born to drug-abusers in their custody

WHEN Clare walks into the room holding her three-month old son, Riley, the
impression is the force of her smile. Frozen as a snapshot in time, the
sight of mother and smiling baby is as perfect an image of motherhood as
you could find.

Yet just last summer, when she discovered she was pregnant, Clare was in
despair, struggling to care for herself, let alone a child. At 38, she had
been a heroin addict for more than half her life and had had to give up two
children for adoption already. Her body was so ravaged by heroin, cocaine,
sleeping tablets, and illness that she had no symptoms of pregnancy. It was
when she was being treated for an infection in Glasgow Royal Infirmary that
doctors discovered her condition and by that time she was around five
months gone.

She had one thought: adoption. "I was totally crazy on drugs," she says.
She was living in a hostel, her parents had died, she had no partner and no
relatives to support her. In the midst of such swirling uncertainty,
keeping the baby seemed inconceivable.

Clare's perspective changed when she was referred to the ward run by Dr
Mary Hepburn of the Women's Reproductive Health Service at Glasgow Royal
Infirmary. Dr Hepburn's team has been supporting drug-addicted women
through pregnancy for more than 17 years and now deals with 200 such women
annually. A multi-disciplinary group of midwives, social workers, health
visitors, and addiction workers assess each mother's ability to care for a
child and provide her with ongoing support after she is discharged.

Clare was no stranger to the ward; she had given birth there before and had
given up her other two children because of her chaotic lifestyle. Yet, as
she chatted to her support worker, she started to think that she might be
able to manage motherhood after all.

She was put on methadone instead of heroin and found supported
accommodation. The perpetual twilight of before had given way to a normal
cycle of day and night, meals and outings, duties and responsibilities.
"It's great getting up every morning, going out, and doing things without
having to stick a needle into yourself or get the tinfoil out." Three
months after the birth, she is clear that staying off drugs is down to her
now, and is deeply grateful for the support she is still receiving from the
hospital.

But should drug users be caring for children? It is a controversial
question, and not one that is often aired in public, but many nurses,
doctors, social workers, and drug treatment professionals are seriously
concerned about such children's welfare. Research shows that exposure to
parental drug use can be profoundly damaging to a child, leading some to
conclude that the babies of drug users should be sent to foster carers
until their parents are drug free. Others believe drug users are victims of
prejudice and argue they can be highly effective parents, given the chance.

Today, the Scottish Executive publishes guidance for a range of agencies
who share responsibility for protecting the welfare of such children. It
comes at a time when child protection is high in the public consciousness.
Yet no-one actually knows how many such children there are in Scotland. The
only firm statistic, from the Scottish Drugs Misuse Database, shows that
around 19% of 11,000 drugs users who sought treatment last year had
dependent children, but the Scottish Executive believes the real total is
somewhere between 40,000 and 60,000.

What is for sure is that these children require to be carefully monitored.
Every so often, a high-profile case of serious abuse throws the issue into
sharp relief. Last year, a 29-year-old drug user called Mark Connelly was
sentenced to a minimum of 16 years in jail for the murder of 33-month old
Scott Saunders, his girlfriend's child, who died after being beaten,
starved, and locked in an unheated room while his mother and Connelly fed
their heroin habit.

Such extreme cases are rare. Children of drug users are not automatically
put on the at-risk register and, indeed, most experts make a distinction
between stable drug users, who can provide a stable environment for their
children, and chaotic users. However, addiction professionals are in no
doubt that in many cases drug abuse compromises parenting.

The Scottish Executive recently reviewed international literature on the
subject and concluded that, while abuse and neglect do not follow
automatically when parents use drugs, substance misuse greatly increases
the risk of family problems. Problem drug use which is the central focus of
an adult's life reduces the time and emotional energy available for
children. Children may be at higher risk of maltreatment and emotional or
physical neglect or abuse. They are also at greater risk of mental illness
and behavioural problems, experiencing social isolation and misusing
substances themselves when older.

Of 111 Child Protection Orders made on children in 62 families in Glasgow
between 1998 and 1999, 40% cited drug-related risk.

Drugs like heroin or tranquillisers that induce sleep can result in
unsupervised children swallowing drugs or having accidents, while cocaine
is implicated in higher levels of domestic violence. Children of drug users
may be made homeless if a parent is sent to prison or admitted to hospital,
and two in every 100 problem drug users in Scotland die.

Sandy Cameron, executive director of social work at South Lanarkshire
Council, describes the plight of children living with chaotic drug users as
"one of the most worrying situations I have seen in 30 years". He and
Professor Neil McKeganey, of the Centre for Drug Misuse Research at Glasgow
University, highlight a need for much more research. "The main worry is:
how quickly is enduring damage done to a child in those early months? Some
of them come to be looked after by us with very disruptive and sometimes
sexualised behaviour," says Cameron. "We're caught in the dilemma of trying
to keep them in the family and I think the question is, do we keep them in
the families for too long before damage is done? Resources for looking
after children are also under considerable strain."

The anti-drugs campaigner, Maxie Richards, believes the best solution is to
put such children into foster care until their parents are able to give up
drugs, citing the example of Norway and Sweden, where such a system is in
place.

Having a baby can and does act as an incentive to give up in some cases,
but the difficult truth is that many mothers lapse back into using drugs
afterwards. "Naively, people think that the motivation of looking after a
child will change people. It doesn't," says Dr David Lloyd, who runs the
neonatal unit at Aberdeen Royal Infirmary. He says that although some women
manage "remarkably well" as parents, he has seen many stay clean during
pregnancy only to go back to using afterwards. "They are, in a way,
selfish, and it's not their fault. After you've been hooked on drugs it's
very difficult. The only way to come off drugs is if you want to, and if
you don't, you come back again and again."

However, Dr Hepburn believes a parent's drug use should not prejudice views
about their suitability as parents. "Fifteen years ago, drug use per se was
seen as a child protection concern and it isn't. It may become a child
protection concern, but just like a middle-class person having half a
bottle of red wine and a couple of gin and tonics could become one.

"If they're not good mothers, it's very often nothing to do with their drug
use, it's something incidental, like coming from a broken home or not
having experienced good parenting themselves."

Dr Hepburn regards stability as more important than enforced abstention.
For heroin users, this means putting them on methadone.

The Glasgow-based public health consultant and architect of Glasgow's
methadone programme, Dr Laurence Gruer, agrees this can improve stability,
but says it does not work in a unified way. Where doctors underprescribe,
or when a patient is under stress, they may top up their methadone with
other drugs.

The danger that even stable drug users might fall off the wagon poses a
major challenge to social workers. There are simply not the resources to
take huge numbers of children into care and even if there were,
intervention by social workers must be justifiable and proportionate to the
difficulties a child is facing.

Prof McKeganey is concerned that addiction workers, who have regular
contact with drug users, may be "too hesitant about inquiring into the
circumstances of clients' children".

The new guidelines seek to make such judgments easier, but another problem
is the shortage of suitably skilled social work staff.

There are some encouraging signs. Schemes like the Harbour Project in north
Edinburgh, launched by the Family Support Unit (FSU) a year ago, have shown
what can be achieved. Staff help parents to stabilise their drug use,
establish structured mealtimes and playtimes, manage budgets, and
prioritise their children's schooling. Above all, they make parents shield
their children from their drug-using activity. "We give people hard
choices," says Brian Cavanagh, development manager of the unit Scotland. He
believes some children they have worked with would otherwise have been in care.

Liz Whyte, headteacher of Royston Primary School, has seen "a dramatic
improvement" in the attendance of all children referred.

Other more general parenting schemes, like Starting Well, also support the
families of drug addicts on the basis that good adult health depends on a
strong parent-child relationship in the earliest years.

Alongside such work, however, Cameron believes there is a need to start
thinking radically, perhaps by encouraging drug-using women to use
contraception. "Part of the harm-reduction approach is to say to a drug
user, 'think about the potential consequences of children coming into your
life'," he says. "We need to think about helping them in terms of
contraception. It may be controversial but I think we need to look at that."

When it comes to protecting the most vulnerable members of the most
vulnerable households, today's guidance may only be the beginning.

How babies born to drug-using mothers are affected

Q. Which drugs are we talking about?

A. The most common are opiates, such as heroin or methadone, and
benzodiazepines, such as temazapam and valium. Combining both is common.
Cannabis is used almost universally; cocaine, amphetamines, and ecstasy
occasionally.

Q. What effect do they have in the womb?

A. Heroin can cause muscle spasms. Spasms in the womb can cause miscarriage
or pre-term labour. Blood vessel spasms in the placenta can cut down the
blood, and therefore nutrition, reaching a baby. Pregnant heroin users are
offered methadone which acts on a 24-hour cycle without fluctuations.
Cocaine constricts blood vessels which can cause placental separation,
reduced brain growth, even foetal death.

Q. How serious are withdrawals in the newly born baby?

A. Some babies have none. Others are irritable and snuffly. Moderate to
severe withdrawals create difficulty feeding, painful diaorrhea, and
incessant crying which can last for months. Convulsions are possible but
extremely rare. Methadone withdrawals last longer than with heroin;
benzodiazepine withdrawals are worse than both; and the worst of all are
withdrawals caused by a combination of both.

Q. Do withdrawals have long-term consequences?

A. Mary Hepburn, of the Women's Reproductive Health Service at Glasgow
Royal Maternity Hospital, says there is no evidence they affect babies'
health in the long run. Laurence Gruer, a Glasgow-based public health
consultant, however, fears that long lasting withdrawals, making a baby
difficult to care for, can compromise bonding. Babies can also
"rewithdraw", having to return to hospital after they have been discharged.

Q. Shouldn't pregnant heroin users be encouraged to come off drugs instead
of taking methadone?

A. Acute heroin withdrawals are thought to be more dangerous to an unborn
child than taking methadone. Besides, if a women cannot cope with being
drug free and goes back to illicit drugs, it will be worse for her baby.

My kids love me Case study

* Lisa, five, and Harry, seven, live with their father Hugh, 40, a
recovering heroin addict who is stable on a prescription for methadone and
valium. Hugh has had custody of his children since they were removed from
their mother, a heroin addict. He is in touch with a parenting support project.

"I was very fearful the kids would be taken into care. My dad was always
there to warn me what was going to happen and he was the one who was going
to do it if I didn't buck up my ideas. I managed to get myself a good GP
and get sorted out with methadone.

"Then I got a prison sentence in 2000. They stayed with mum and dad for
nearly five months, then they went into foster care. When I came out of
prison, Harry, all he wanted was to get back home to his dad again. I don't
think the foster carers realised just how close the kids were to their dad.

"If I say, kidding on, 'I'm leaving' and go out and shut the door, it's
pandemonium. One day I was going from the park 100 yards to my mum's house.
The kids were playing in the park and they asked me where I was going. I
said I was going to the house, 'I won't be a minute'. But for some reason
they didn't believe me and they started screaming. That insecurity's still
there, but that's down to me. I let them down when they ended up in foster
care.

"Both kids are doing great at school, but outside school . . . Harry was
enticed to go stealing. He was pushed into doing it. He's been harassed and
bullied.

"I'm determined to get a new house. They won't sleep in the bedroom. We all
sleep through in the living room on mattresses, because they're frightened.
The house below us and the house opposite us, the windows were getting smashed.

"I met our parenting support worker last summer and she started coming down
round the house. The kids got to know her and they started summer trips.
She got me involved and it was something that, yeh, I enjoyed.

"They are definitely much happier with me than in foster care. I know that
they love me. I keep telling them to listen to what I say - 'I don't want
you going down the same road I went down'. If I'm in the toilet for any
more than five minutes, Lisa will want to know what I'm doing. I can't have
tinfoil in the house or anything like that because they'll think I'm going
down that road again.

"I feel like if I can get out of the rat hole we're in I can start to work
on reducing what I'm getting from the doctor.

"People like their headmaster, our home support worker, my mum and dad have
been great. If it wasn't for all them, possibly the kids wouldn't be with me."

Names have been changed.