Each year, several hundred babies born in the District struggle with drug withdrawal because of their mother's drug and alcohol use, according to pediatricians and nurses in local hospitals, clinics and drug treatment programs.
At D.C. General Hospital, which handles deliveries of drug-addicted mothers referred through a city clinic, the number of babies born with signs of drug withdrawal has nearly doubled since the hospital first looked at the problem in 1982.
According to hospital records then, 52 babies were born with drug withdrawal symptoms, about 3.2 percent of all deliveries, but three years later 108 such babies were born at the hospital, which represents 5.7 percent of the 1,883 births.
"This only represents those mothers who admit to drug use," said Dr. Yvette Reid, a neonatologist at the hospital. "We have many mothers who don't think marijuana, alcohol and PCP are significant drugs."
Several other hospitals in the District report an increase in the number of substance-abusing women delivering children, but they have not collected figures that document this.
"Nobody's counting, but the problem is very big in the city," said Joyce Thomas, director of the protective services division of Children's Hospital National Medical Center, which is increasingly being asked by other hospitals to care for the tiny victims in its intensive care nursery.
The District's agency responsible for substance-abuse problems, the Alcohol and Drug Abuse Services Administration, offers detoxification help for women at its Women's Services Clinic on the grounds of D.C. General Hospital. The clinic coordinator said that about 35 of the 170 women seen monthly at the clinic are pregnant. In past years, about 10 to 12 of the patients seen each month were pregnant, she said.
At the clinic, social workers encourage heroin addicts to use methadone, a drug that creates less serious problems for mother and baby.
Despite attempts by District social workers and others to encourage abstinence, some mothers are unable to give up their drug use permanently and resume use shortly after giving birth, local doctors said.
At D.C. General, babies born to mothers who admit using drugs are watched for 10 days for symptoms of withdrawal, Reid said.
Dr. Stanley Sinkford, chairman of pediatrics at the hospital, said the often grossly underweight babies mimic adult experience with drug withdrawal. "They have seizures, convulsions, often are very jittery, irritable and hyperactive," he said.
If mothers are abusing heroin or other opiates, the infants are given paragoric, most commonly known as an antidiarrheal medicine, which dulls their senses. After the infants' symptoms subside, the babies are weaned from the medicine, Sinkford said. Other infants are swaddled, given pacifiers and kept in quiet environments to calm their distressed nervous systems.
Recovering from their mothers' drug use can take as little as a week or as long as three months, depending on the babies' weights. "Not everyone makes it," Thomas said. "We have several deaths a year."
After delivery, those mothers identified by hospitals as having drug problems are counseled by hospital and city social workers. Under a city contract with the Visiting Nurses Association, a portion of the drug-affected infants are assigned to visiting nurses who check the babies' progress for up to eight weeks after they go home.
"Many of these mothers don't have a consistent address, so a grandmother or aunt is taking care of the baby," said Judy McLoughlin, director of special projects for the association. "It's very common for these babies to have development delays and mental retardation."
Of the 269 babies followed last year by the visiting nurses because of concerns about the infants' environment or physical condition, nine were afflicted with drug problems. In the first five months of this year, eight of the 59 babies followed had drug-abusing mothers, McLoughlin said. "There is a noticeable increase in the amount of drugs in the population of teen-age mothers," she said.
The babies often are released to their mothers "if the mother is rational and we've got protective services checking to see that no further damage is done," Reid said. In other instances, city officials persuade mothers to give up their children for foster care or adoption.
However, there is often lasting physical damage to the children caused by the drug exposure. This causes these infants to linger in public custody because many prospective parents are not willing to accept such children.
"The story is not in yet on their later life," Sinkford said. "We have a high incidence of addicted mothers in the District of Columbia and know we have many children with learning disabilities. There's undoubtedly a connection, but no one has tracked these infants in later years."