U.S. Air Force photo by Ken Wright
A couple weeks before President Donald Trump declared the opioid crisis a national public health emergency, First Lady Melania Trump visited newborns going through drug withdrawal symptoms at Lily’s Place, a treatment center in West Virginia.
Likely inspired by this visit, President Trump said in his much-anticipated announcement last week that in West Virginia, “there is a hospital nursery where one in every five babies spends its first days in agony.”
“These precious babies were exposed to opioids or other drugs in the womb,” Trump stated. “They endure nausea, pain, anxiety, sleeplessness, and have trouble eating, just as the same adults undergoing detox.”
Problem is, Trump’s panicked focus stokes national anxiety about drug use “victims” while failing to acknowledge treatment solutions that are proven to work and yet remain hopelessly underfunded.
Instead, concern about “addicted babies” manifests in over-treatment and over-hospitalization of children and the demonization of mothers.
Concern about “addicted babies” manifests in over-treatment and over-hospitalization of children and the demonization of mothers.
Newborns at Lily’s Place are indeed treated for Neonatal Abstinence Syndrome— a diagnosis of withdrawal symptoms after in-utero exposure to opioids. But every baby exposed to drugs in utero is not guaranteed to experience the “agony” Trump describes, or even any withdrawal symptoms at all.
Dr. Sean Loudin, medical director at Lily’s Place, believes Trump’s 1 in 5 figure came from annual research his group performs on babies born at their local hospital, where he found 19 percent of newborns were exposed to illicit drugs (excluding alcohol and cigarettes) in-utero.
“Most babies who are exposed will have symptoms of withdrawal,” he confirms. But “whether or not they are bad enough to require treatment varies by individual, baby by baby,” Loudin tells The Progressive.
These details are important because increasing rates of Neonatal Abstinence Syndrome diagnoses are causing a panic with real and tangible consequences for both the babies diagnosed and their mothers. That, plus a lack of empathy for drug users, Loudin said, can cause people to believe, erroneously, that a mother who uses drugs during pregnancy cannot love or care for her child after birth.
The victim-perpetrator binary even penetrates the criminal justice system: Tennessee, for example, briefly enacted a “fetal assault” law (that has since lapsed under a sunset provision) whereby a woman who used drugs during pregnancy could be charged with and jailed for a crime against her own body.
Lynn Paltrow, executive director of National Advocates for Pregnant Women said her organization was “disappointed” that Trump used his speech “to perpetuate dangerous and inaccurate information about pregnant women and the transitory and treatable symptoms experienced by some newborns exposed prenatally to opioids.”
Women fearing interventions from child protective services often avoid prenatal care, she said, increasing a host of risks associated with pregnancy while also deterring them from seeking-out the treatment interventions most effective for pregnant drug-users.
But mothers who use opioids during pregnancy are typically not encouraged to pursue abstinence which can cause complications including miscarriage and carries the risk of relapse, but are referred to maintenance medications like buprenorphine and methadone.
In Huntington, there are two programs where pregnant women can seek maintenance treatment, “and both of them have waitlists,” Loudin said.
So rather than pit the mom against the baby, as Trump’s rhetoric encourages, doctors are working to establish an early, healthy relationship among the mom-baby unit.
Trump's rhetoric encourages pitting the mom against the baby. Doctors are working to establish a healthy relationship among the mom-baby unit.
Like all babies, says Dr. Matthew Grossman, a treatment provider and researcher of Neonatal Abstinence Syndrome at Yale New Haven Children’s Hospital, those with the syndrome need to be evaluated and treated individually. Biases about what we believe drug use during pregnancy should do, he adds, must be set aside.
In a study published in the Journal of Pediatrics this May, Grossman found that moving away from the “Finnegan score”—the standard tool for diagnosing Neonatal Abstinence Syndrome—led to significant reductions in the most serious of treatments. The Finnegan score, a checklist of behaviors like yawning and nasal stuffiness, has been increasingly criticized for its susceptibility to bias.
When Grossman’s team focused instead on the infant’s ability to eat, sleep, and be consoled, the results were stunning. In two years, the average length of hospital stay shot down from around 22 to about 6 days, and the percent of methadone-exposed newborns requiring morphine treatment plummeted from 98 percent to 14 percent.
“Outside of prematurity, [Neonatal Abstinence Syndrome] is the longest length of stay of any diagnosis in pediatrics, and it doesn’t need to be,” Grossman said, noting that the number of babies with the syndrome in Neonatal Intensive Care Unit [NICU] beds has “quintupled” in recent years.
The environmental conditions—lighting, noise, and social isolation—of NICUs can actually exacerbate symptoms of the syndrome, he added.
Loudin says, “We’ve decreased in a four-year period of time the number of babies treated for withdrawal in the NICU from 100 percent to about 22 percent.” The shift saves taxpayers $11 million in hospital charges, he said.
In addition to the move out of the NICU, providers are promoting skin-to-skin contact, encouraging breastfeeding, and advocating “rooming-in”—allowing the mom and baby to bond and learn to soothe and be soothed.
Trump followed his remarks about “beautiful, beautiful babies” in withdrawal with comments on “the growing ranks of America's opioid orphans.”
“Beyond the shocking death toll, the terrible measure of the opioid crisis includes the families ripped apart, and for many communities, a generation of lost potential and opportunity,” he added.
But the Trump administration’s hostile relationship with comprehensive federal health care policy—including contraception and abortion access—flies in the face of its own scaremongering.
The administration’s hostile relationship with comprehensive health care policy—including contraception and abortion access—flies in the face of its own scaremongering.
Dr. David Jude, Chair of Obstetrics and Gynecology at the Marshall University School of Medicine in Huntington stresses the importance of care that does not begin with pregnancy and end at birth.
“Many of these women have coexisting mental health issues, especially depression and post-traumatic stress disorder. I believe that it is important to treat their addiction and the often underlying mental health issues that complicate their recovery,” Jude said. He added that birth control access can also “play a big part in determining their ability to care for their children and themselves.”
“Nothing in the speech acknowledged the obstacles his own position on the Affordable Care Act would create for pregnant women who need that care,” said Paltrow of NAPW. “Nothing acknowledged or addressed the extent to which hospitals are failing to provide effective evidence-based care to newborns who do show symptoms and need not suffer. Nothing addressed the many ways in which pregnant women in the US are punished when they do seek help.”
Kristen Gwynne is a drug policy reporter whose work has appeared in publications including Rolling Stone, the Guardian, and VICE.