Her newborn in withdrawal, a young mother faces her own recovery.
“Where’s everybody headed?”
Ellen is riding up the elevator at Women & Infants Hospital, on her way to see her newborn in the nursery.
Ellen (we’re not using her last name to protect her son) is 26. She’s tall and blonde, wearing sweatpants and sneakers. And she’s carrying a plastic bag full of bottles of breast milk she’s pumped for her son, Jonathan. She hands it to the nurse who lets her in.
She’s only got an hour or two to visit Jonathan before she has to catch her ride home. Home now is SSTAR Birth, a residential substance abuse treatment program for mothers with young children. And that’s where Jonathan will join her when he’s stable.
“Has he had any morphine today?” Ellen asks the nurse.
Jonathan has been on a steadily decreasing dose of morphine to help him withdraw safely from the methadone he was exposed to in the womb. Ellen takes methadone to curb cravings and keep from going into withdrawal herself, from heroin. Methadone’s an opioid, like heroin, but a doctor prescribes it, and it’s not supposed to get you high.
“Here he is!”
Ellen wheels Jonathan’s bassinet into a private room where she can talk and cuddle with him. He’s swaddled tight in a cotton blanket, and a tuft of brown hair peaks out from the bundle. For now, he’s calm and still.
But Ellen knew he’d struggle soon after he was born.
Painful withdrawal symptoms
“This is my second son, my first son was also born when I was on methadone,” she recalls, “so I had an idea of how it worked.”
“It” is neonatal abstinence syndrome, or NAS, and it’s a collection of symptoms a baby develops going into withdrawal from the opioids his mother took while she was pregnant. Hours after he was born, Ellen says the doctors and nurses were looking for symptoms.
“They came in every four hours and they would test his reflexes, and they were asking me was he having any loose stool, any spit up,” said Ellen. “He was having some tremors on Saturday, the day after he was born. He was tremoring kind of a lot. So that scared me.”
So did the stiff limbs and fast breathing. So doctors started treatment: low lighting, a quiet environment, tight swaddling. NAS babies have a hard time with lots of stimuli. Plus they gave him morphine, to ease his symptoms.
“And that was tough,” she says with a sigh. “I was emotional when they told me they had started medicating him. But I also don’t want him to be uncomfortable.”
Dealing with the guilt
As you might imagine, Ellen feels guilty about what Jonathan has gone through.
“He’s not an addict. He didn’t choose to be on methadone,” she reasoned. “You know, the first thing they experience when they come into this world is detox. I just, it’s easy for me to kind of sit and feel sorry for myself but that doesn’t help anybody. I also know that I’m at a place and was in a place where if I wasn’t on methadone it could have been something a whole lot worse.”
It could have been heroin. Ellen has been in and out of treatment for addiction since high school. She stayed clean during her first pregnancy but started using again as soon as her first son was born. It got so bad, authorities found her slumped and sedated at a bus stop, her baby in a stroller nearby.
“The police had to wake me up, then [they] brought me to the DCYF [Rhode Island Department of Children, Youth, and Families] office. It was obvious I was using something, and I wasn’t allowed to leave with my son.”
And because of DCYF, her first son was adopted by a family Ellen says she admires and appreciates. Losing her first son was a blow. But Ellen says it led to a wake-up call: “That is finally when I was able to say, ‘I don’t want that. I don’t want to live like that. I never felt that desperation, like that true desperation that I will do anything to stay clean. I’ve said that in the past but I’ve never really felt it. I felt like, I’ll do it as long as it’s not uncomfortable. I’ll do it as long as it’s not hard. And it is uncomfortable and it is hard.
But Ellen says she’s up to it. It’s tough, but she appreciates the structure in her residential program, like the daily counseling sessions.
“Monday through Friday we have groups. They have a daycare right on the premises with amazing staff. We wake up in the morning, get the kids breakfast, you have your own room, your own bathroom.”
Now it’s time to wheel Jonathan back to the nursery. Before Ellen leaves, pediatrician Jeanne Ziter pulls her into a room to talk discharge planning. Soon, Jonathan will be ready to go home.
“So we’re at the point where we stopped the morphine today, and then we’ll want to watch him two to three days,” she tells Ellen.
But Jonathan may still be uncomfortable for a few weeks or more. And for that, Ellen will be sent home with another medication for him, phenobarbital, which doctors say is usually for seizures but seems to help babies going through withdrawal. Ellen knows she’s also got a long road ahead, to stay clean, to deal with the guilt.
“I feel like I’ve just been able to begin to let go of some of that guilt. There’s a lot of people out there that would hear my story—the fact that I’m sitting here saying all this holding a baby—not everyone understands, and I get that.”
She says she’s trying to do the right things now, for herself and for Jonathan. She says goodbye to him, takes the elevator back to the lobby, peels off her visitor badge, and heads outside and into the waiting white van.
(5/7/14 UPDATE: Jonathan has been discharged from the hospital. Mother and baby are both doing well.)
Kristin Gourlay is a reporter for Rhode Island Public Radio.