CRACK BABIES: UP FROM ROCK BOTTOM

'This Is Not a Baby I Am Going to Lose'

In the 1990s, experts warned that damaged children born to addict
moms would overwhelm social systems. Now, science finds exposure to
cocaine may wreak less havoc than alcohol or even tobacco -- hopeful
news for families who yearn to turn their lives around.

Jean looked at the ultrasound photograph of her unborn baby, taken
precisely at 1:24 p.m. on May 5, 2001. She hardly could believe her eyes.

This time, things would be different, she thought. This baby wouldn't
be put up for adoption. At 39, and after two decades of crack cocaine
use, she was being given another chance to be a mother.

Jean had given birth to another girl more than a decade earlier, in
1989. She hadn't meant to give her up. But when she went into labour,
she was in a Toronto crack house. After her daughter's premature
birth by cesarean section, she returned to pick up her luggage.
Someone offered crack. She couldn't resist, and never made it back.
When the girl was sent to a new home eight months later, only Jean's
mother came to say goodbye.

At the time, Jean couldn't bring herself to admit that her daughter
had been taken away.

"I wanted to punish myself - I told people she died." And, she says,
"I used harder than ever," spending $800 to $1,000 a day to feed her
habit, which she financed by scamming people, often getting men to
pay for sex and then slipping away before they could complete the bargain.

This time, she was determined to keep her child. She raced downtown
to tell the father the news, pressing the grainy ultrasound image
against the Plexiglas barrier between them. He was thrilled, but he
was in custody at the Don Jail, charged with trafficking. He was a user too.

A decade ago, infants such as Jean's daughter, "crack babies," were
an object of panic, considered a lost cause. The 1994 Mayor's Task
Force on Drugs in Toronto heard estimates that each year, 5,000
babies born in that city's hospitals had been exposed to cocaine. A
school trustee predicted that their needs would be a huge burden.

Even today, the stigma remains: Jean asks the newspaper not to use
her real name.

But those nightmares don't seem to have come true. In fact, studies
hint that babies exposed to cocaine in the womb may suffer only
subtle effects, much less than from a mother's regular or excessive
alcohol use. Long-term questions remain, but the truth seems far from
the alarmist headlines of the early 1990s.

This research comes as a relief to doctors and child-welfare
agencies. But it also generates some anxiety: The fact that crack is
not as devastating as we thought is not exactly a public-service
announcement any one wants to make to pregnant women.

For someone like Jean, however, it's a godsend.

'The Next Thalidomide'

"Reports in the 1980s described crack cocaine as the next
thalidomide," recalls pediatric toxicologist Gideon Koren, who is the
director of the Motherisk Program at the Hospital for Sick Children in Toronto.

Prescribed in the late 1950s and early 1960s to combat morning
sickness, thalidomide provided living proof that a drug could bypass
the placenta to cause major malformations, such as blindness, cleft
palates, poorly developed organs, and missing or misplaced limbs.

In the 1980s, as crack, the bargain-basement and highly addictive
derivative of cocaine, took hold among North American drug users,
there were comparable stories of infants born with malformed genitals
and missing fingers.

"There was a big apprehension that a whole generation of babies
[would] be affected," Dr. Koren recalls.

Much of the early hysteria was due to studies that found brain damage
in rodents exposed to cocaine.

And years later, when scientists dissected the brains of baboons that
had been exposed to cocaine in the womb, they found the central
nervous systems had been severely damaged and neurons were missing.

There is no doubt the drug poses a threat. It can constrict blood
vessels in the umbilical cord and placenta, which can block the flow
of oxygen and nutrients to the fetus.

Intuitively, though, cocaine was thought to be much more ominous than
alcohol, which can cause birth defects ranging from impaired vision
and heart defects to irreversible brain damage and abnormal facial
features, depending on the severity of the exposure and genetic and
environmental factors.

In fact, research so far suggests that crack may not even be as
harmful to a fetus as half a pack of cigarettes a day -- which can be
bad enough, causing stillbirths and sudden infant death syndrome, but
doesn't raise the same alarms.

Tobacco has been under investigation for decades longer, so it is not
clear if cocaine will "catch up." But in perhaps the biggest analysis
so far, a team led by Deborah Frank, professor of pediatrics at
Boston University School of Medicine, looked at 36 studies of
prenatal cocaine exposure in a paper published in 2001.

They found no strong evidence that prenatal cocaine exposure causes
adverse developmental consequences in children up to the age of 7.

Moreover, many findings once thought to be specific effects of
cocaine exposure in the womb can be explained by other factors,
including prenatal exposure to tobacco, marijuana or alcohol, not to
mention the early-childhood environment. Language impairment, for
example, is just as likely to be due to a mother's tobacco use.

"There's this incredible stigmatization of cocaine," Dr. Frank says
from Boston. People think that "if Mother is using it, it is
'deviant' behaviour [and] therefore her child will be a deviant," she says.

No Two Alike

In an east Toronto suburb, a red plastic baby swing hanging from a
tree in the front yard distinguishes the home of John and Liane
Niles. For 15 years, Mr. Niles, a United Church minister, and his
wife have been emergency foster parents. Many of their young charges
have been exposed to drugs while in the womb. Some are named for
mom's substance of choice -- Brandy, Johnny Walker or even Crystal.

Until last week, the Niles were caring for two boys whose mothers
used crack. The elder, at eight months, looks like a classic Gerber
baby, with creamy white skin, blue eyes, blond hair and a sunny
disposition. His large head disguises the fact that he's small,
though not underweight.

His mom was high when he was born. "We picked him up straight from
the hospital," Mr. Niles says.

But he has met all the important targets -- rolling over at the right
time, smiling when cuddled and kicking his legs energetically. He is
starting to crawl and can pull himself to a standing position.

Last week, he was scooped into the arms of adoptive parents.

The second boy, six months old, is small, too. But for his first few
months, he didn't respond to cuddling and never made eye contact.
Recently, he has come around, though a doctor told the Niles that he
likely will experience some developmental delay.

"There are kids who in life for whatever reason can rise above it,
and aren't as affected," said Ms. Niles, a former social worker.
"Whether that has to do with what mom did, the timing, what she mixed
it with, no one really knows."

Between half and three-quarters of youngsters in the care of the
Children's Aid Society of Toronto have been exposed to alcohol or
drugs in the womb, including cocaine, says Cathy Breton, director of
foster care and adoption.

For some parents, this makes adoption a frightening prospect. One
Toronto couple looking to adopt studied the risks and decided they
could take on a child who had been exposed to drugs, but not one with
fetal alcohol syndrome.

Their first daughter was 15 months old when they got her home. She
had been exposed to one of the highest level of crack that
child-welfare authorities said they had ever seen.

They later adopted another girl, then 4, not known to have been
exposed to any substance abuse in the womb. Now 10, she is a
straight-A student who is athletic and fun-loving.

Her eight-year-old sister seems bright too, but she is experiencing
learning delays. Her father isn't sure whether the crack is to blame.
Whatever the case, he has no regrets.

"Every child deserves close attention and care," he says. "And any
child who receives that will do very, very well. That's where she is,
and she's doing extremely well. We're completely happy."

What's The Difference?

Why do some crack-exposed infants thrive while others do not? With
thalidomide too, only 30 to 40 per cent of exposed infants bore the effects.

Dr. Koren looked into the question by testing hair taken from twins
born to a crack user. Proof of fetal exposure lingers long after the
crack high fades, as cocaine and its metabolites leave a record in
the hair shaft.

(It is particularly telling because the fetus's hair grows during the
last three months in the womb, long after the mother would have known
she was pregnant.)

He found that one twin's hair sample had a high level of the drug,
while the other's was undetectable. Why? The hypothesis concerns the placenta.

Fraternal twins grow in the same womb but have separate placentas.
Dr. Koren says one twin's placenta must have protected the fetus,
while the other did not. The twins' bodies also may have metabolized
the drug differently.

But even the twin with the higher exposure may not fare badly. "Kids
have an ability to recover," Dr. Koren says. "There's no question
that, however you slice it, cocaine is not alcohol, and the vast
majority of babies will do okay."

He adds, "I know it intuitively doesn't make sense, but we have not
seen much with cocaine. ... It was not easy to bring this news, as
people say to themselves, 'If it's bad, it cannot be good.' "

That thinking has prompted extreme responses to crack and pregnancy
growing from the U.S. war on drugs and its struggle with abortion.

A controversial charity called Project Prevention -- also known as
Children Requiring a Caring Kommunity -- offers $300 (U.S.) to any
drug user who agrees to be sterilized or use birth-control implants.

As well, since 1985, more than 300 women there have been arrested
under child-endangerment laws for using drugs or alcohol while
pregnant. At least 100 were, at some point, cocaine users, says Lynn
Paltrow of New York's National Advocates for Pregnant Women.

Science may show that such Draconian measures are out of proportion
to the danger, though it's still early to say.

Since 1991, University of Florida researchers Marylou Behnke, a
neonatologist, and Fonda Davis Eyler, a developmental psychologist,
have tracked about 300 babies; half of their mothers used cocaine
during pregnancy and the other half did not.

They find that the more cocaine a mother ingests while pregnant, the
smaller her baby's head will be -- and the smaller the head, the
worse the baby's outcome will likely be.

By the time such children had reached 5 and 7, they had suffered a
mild loss of "executive function," meaning they could not solve
problems and organize quite as well as their peers. That loss has
persisted to the age of 10.

So far, however, even those children have suffered no devastating
effects. The real test will come when they are teens, Dr. Eyler says.
"Will these kids engage in more risky behaviours, including drug use
and other problems?"

Dr. Koren says the ability to recover from prenatal exposure is a
tribute to the "plasticity" of the infant brain, but it needs the
right environment. Put a crack-exposed newborn in a loving home;
feed, nurture and stimulate her like any other; and in all likelihood
she will turn out all right.

"Attachment is crucial," Dr. Koren says. "The ... brain can't
regenerate itself unless you get the environment we all take for granted."

Conversely, even the healthiest baby placed with a mother who is
still addicted to drugs is likely to suffer terribly.

Breaking the Cycle

When she learned she was pregnant again, Jean worried about what her
drug use had done to her unborn baby.

But to her surprise, the hospital staff "told me that a lot of babies
don't have any problems. ... I thought it was too selfish of me to
have this baby, but the hospital gave me hope," she remembers. "I was
so excited."

Jean's own life had a grim start. She was forced to live with various
relatives in Ontario and Manitoba, sexually abused by one male
relative at when she was 6 or 7 and by another at the age of 8. One
of her earliest memories is of pulling up to the living-room table to
drink suds from empty beer bottles. She dropped out of school in Grade 10.

At the start of her pregnancy, her crack habit was costing $400 a
day. It was less than half of her usual intake, because she was
trying to wean herself off, but still amounted to smoking 20 pieces
of rock a day.

Now, she would have to quit her two-decade-old habit, along with
cigarette smoking.

During her withdrawal, done in the hospital, she suffered body
twitches, involuntary reflexes and nausea. But afterward, she became
fanatical about nutrition, making sure to take her prenatal vitamins.
If someone was smoking, she walked out of the room.

Jean credits much of her recovery to Breaking the Cycle, a one-stop
program in Toronto that tries to get pregnant women off drugs or
alcohol, to help them keep their babies and start a new life. A
similar program exists in Vancouver.

"Oftentimes, they've had more than one child apprehended," says
Margaret Leslie, director of early-intervention services at
Mothercraft, a non-profit organization that oversees Breaking the Cycle.

"They come in thinking, 'This has to stop. This is not a baby I am
going to lose.' "

At Breaking the Cycle, Jean received one-on-one and group counselling
as well as relapse-prevention and life-skills training. As well, new
mothers are taught child nutrition, often learning how to eat
properly themselves for the first time.

Dr. Koren comes in weekly to assess babies who were exposed to
prenatal drug use and answer any questions new mothers may have.

"Everybody was sharing their experiences of what can happen when you
least expect it," says Jean, who went there three or four times a week.

On an unseasonably warm morning in November, 2001, Jean's daughter
was born, alert, healthy and weighing 7 pounds, 14 ounces.

She has been subjected to frequent checks to determine if she was
meeting her milestones. She not only met but exceeded them, taking
her first steps at eight months -- the same month she first said
"mama," as Jean recorded in her baby book.

Today, at 44, Jean's skin is creamy white, lustrous hair hangs over
her hazel eyes and she has blossomed into a bright, personable woman
who shows no hint of her tragic past.

She is in her fourth year at a university, earning As and Bs as she
studies to become an addictions counsellor. (After all, only a smart
woman could survive for two decades as a crack addict.)

By the age of 4, her daughter had tested as having an IQ of 135,
putting her in the top 1 per cent of the population. Today, she is a
thriving five-year-old in senior kindergarten.

On this winter's day, the girl returns from school, begging for
chocolate. Jean allows three pieces, but refuses a persistent request
for hot cocoa.

As in any other home where there are kids, toys have a way of
crowding all the adult things in their two-bedroom, west Toronto
apartment. There are pink plastic sunglasses on a table, a wooden
dollhouse on the floor. A stuffed, green Grinch rests atop the couch.

In the hall, there are framed photos of the girl's father. In one,
she is sitting on his lap, celebrating her first birthday. In
another, he resembles rock musician Lenny Kravitz.

Her dad tried to stay clean, going to detox and then wanting to join
a program, only to find out the wait lists were months long. Jean
says he fell through the gaps.

"He did live with us," she says. "He got a job, stayed clean, but he
just couldn't keep it together. He would relapse, then go to jail."

One Sunday night in August, 2005, he left a telephone message: "I've
just used for the last time." His voice was eerie, marked by fear.
Jean listened to the message twice, and then erased it.

The following Wednesday, Toronto Police identified a man who had
jumped from the overpass where King and Queen Streets meet, a
desolate area where crack addicts would congregate. They told Jean
they had known him by the fingerprints from his criminal record.

Their daughter still cries for him. Another loss haunts Jean, too --
her first daughter, who last month celebrated her 18th birthday.

In 1990, a year after the girl was born, Jean temporarily quit crack
after undergoing treatment programs in Texas and Chicago. Longing for
her child, she called the Children's Aid Society of Toronto to see
what her rights were, if any.

"The worker said, 'What do you have to offer her? She's been adopted,
she has a brother,' " Jean recalls. " 'What do you have?' "

Ashamed and feeling the worker must be right, Jean hung up the phone
and dropped the matter.

Now, Jean has put her name on the adoption registry, hoping the child
will look her up. There is so much she wants to explain. Mostly,
though, she just wants to know if the young woman is doing well.

Meanwhile, she is looking forward to a new life after she finishes
school, working as a counsellor to help people still grappling with addictions.

"In a few years, I have plans to get a small house, with a dog and a
fence," Jean says. "I have all these dreams."