Saturday, May 13, 2006

Pink II

There were so many interesting comments on my Pink post that I couldn't resist making some more comments about drug using mothers and our reactions to them. As I tried to say in the post, I'm not really serious about forcing them to be sterilized, but it does, I think, show the measure of the caregivers' frustration with these moms that they would think of the possibility of sterilizing them. Ariell makes an interesting point, too, about possibly requiring them to get a depo-provera (birth control) shot to get their checks, but as Flea points out, civil liberties are too important in our country, appropriately so.

We don't see many methadone mothers in our hospital because the methadone program for pregnant women in our area is located in a hospital across town. Most of the drug using moms we see are cocaine users. Their kids don't have as bad withdrawal as babies whose mothers used opiates such as heroin or methadone. There is some debate about whether cocaine harms the developing fetus. I haven't exhaustively studied the subject in the last couple of years, but I think that fetuses are relatively unscathed by intrauterine cocaine exposure. When cocaine became the popular drug in the late 80's and early 90's, there were some gloom and doom articles in the popular press saying we would have an epidemic of "crack" babies who would all reach kindergarten at the same time and need special education, putting an unbearable strain on our educational system. That hasn't happened, a testimony to the incredible resilience of the fetus and newborn. By the way, I don't allow residents and students in our NICU to use the term "crack" babies, a derogatory term that pegs them as losers before they even have a chance.

I like to ask the residents, "What is the worst common drug of abuse you can take in pregnancy, in terms of harming the fetus?" Some of them get it right, even though it's a bit of a trick question. The answer is alcohol, the only legal drug of the bunch. Alcohol causes growth and brain retardation and mental deficiency. If you're looking for a good long term outcome, give me a baby of a heroin or cocaine addict any day over that of an alcoholic mom.

In closing, I'd just like to point out a group of people who are probably especially frustrated with drug using moms, and that group is the infertile nurses who work in the NICU. We have two such nurses in our NICU now, both in their mid to late thirties, who have been struggling to have a baby for years. It must drive them crazy to see moms in their early twenties with 4 or 5 kids, and drug using moms with 8 or 9 kids, all dropping babies like rabbits, when they can't even have a single child. My heart goes out to them.


Anonymous Rikita said...

I just wanted to say you are an excellent writer and I really enjoy reading your blog. You are compassionate and thoughtful and I am so glad you chose to be a neonatologist. My experiences in the NICU left me with enormous admiration and respect for the doctors and nurses. My twin sons (their nicknames are Sammy and Stevie) were born at 24 weeks 6 days gestation 14 months ago, weighing 1 lb 12 ounces each, and they came home a few days before their due date. They are doing great -- cruising along furniture, babbling, making each other laugh, eating well and gaining weight. In the beginning I had a lot of guilt and fear. I was so worried that they would have a poor quality of life (and, by the way, it wasn't the doctors giving me that idea, it was my own anxiety due to reading the statistics and preemie books and web sites -- actually we were fortunate, because they didn't have brain bleeds or BPD or CP, and they came home without oxygen or monitors -- though Sammy did get NEC and had an operation to remove 1/3 of his small intestine -- the doctor said the fact that he survived showed he was very strong and that 8 out of 10 babies would have died.) Secretly, in my heart, I sometimes felt that all the technology was wrong, that maybe they should not have survived, and I had a lot of guilt over that, over having used fertility treatments and thus "going against God's will," and over how much medical resources were going to my family -- we have insurance, but I felt like I was part of the reason insurance costs are skyrocketing. But, as I regained my sanity after the first three months they were home, I saw what a blessing medicine has given us. Sammy and Stevie are the light of our lives and every day they give us joy. We love them so much. Every day I give thanks. So when you're having a bad day or week, please know that you are doing wonderful work and that countless parents out there are infinitely grateful for people like you.

11:28 PM  
Blogger neonataldoc said...

Thanks so much for the kind words, Rikita, and congratulations on your sons. I know that children can be the light of people's lives, and it's my privilege to help some kids make it home to their parents.

5:43 PM  
Blogger That Girl said...

I have to disagree - my brother was a "crack baby" as was a cousin (both adopted into the family) and the behavioral problem that both have are immense and hard to resolve.
Along with other kids in the same boat, they seem to have hyperactivity, "anger control" issues (and I say that ironically because "out of control" is more like felony-behavior in these children), impulse control.
Perhaps physically they are well but I have never seen one of these children that wasnt destined for jail.
I would also like to say I have never understood envy. Being upset because you judge someone as less worthy who has what you desire is the essence of priviledge.
I often think to myself - these infertile woman imagine having perfect babies. No infertile woman says to herself that her child might be seriosuly, fatally ill, or deformed.
Perhaps if we left behind the notion that the essence of womanhood was procreation both kinds of mothers would be better off.

10:41 AM  
Blogger That Girl said...

Since everyone, especially doctors, like studies:

12:26 PM  
Blogger Emma B. said...

Actually, that_girl, I'd say infertile women are probably *more* likely than your average mother to consider the possibility of a less-than-perfect baby. Many of us are older, and automatically at higher risk for genetic issues. Others have suffered multiple miscarriages, and know or suspect that something is amiss with them or their partners chromosomally. And some of us are young and healthy, but we can't quite accept that even if we do get pregnant, something else won't go wrong. If we've thought about adoption, we've asked ourselves just what kinds of conditions we'd be willing to accept in a child. How many mothers with normal pregnancies and histories think about those things?

I'm currently 20 weeks pregnant after infertility treatment, and believe me, I'm aware that my babies may be anything but healthy. After all, I've already had to decide if I wanted the triple screen, the CVS, the nuchal fold translucency screening, and the amnio, and tried to determine what we would do if the much-longed-for baby had a serious physical condition. And given that I'm pregnant with twins (hardly a rare occurrence with assisted reproductive technology), I can promise you that not a day passes where I don't think about the possibility that they'll be born very prematurely and have lifelong mental and/or physical defects.

I don't think most infertiles have kind of the happy sunshiny mommy fantasies you talk about. If we're not pregnant, we tend to be bitter rather than naively optimistic; and if we are, mostly we just tend to hope the baby doesn't die. Infertility is one of those things that wounds you deeply and takes a long time to get over, and seeing two lines on a pregnancy test doesn't automagically cure it.

2:32 PM  
Anonymous Amka said...


I hope this doesn't sound like people coming down on you, but I would also like to disagree with something.

Procreation isn't just some cultural fad that passes after a few decades or centuries. It isn't some male dominated conspiracy to limit women. We are hardwired by millions, even billions of years of evolution to desire procreation. It is expressed differently in every woman and man. Some in fact do escape feeling this need deeply. Some transfer it to other efforts. But it is, in fact, part of our essence.

3:20 PM  
Anonymous Anonymous said...

my question is simply this: when will our focus on civil liberties take into account the civil liberties of the children? who is championing the children and seeing that they are getting the best? it is this that breaks my heart. we will protect a crack addict's "right" to having children before we even consider the children's rights to a safe, nurturing environment.

5:02 PM  
Anonymous Depo-Provera Prescription Information said...

My name is Janice Still and i would like to show you my personal experience with Depo-Provera.

I am 24 years old. I have been on Depo for 9 years and did not realize that the symptoms I experienced might be related to the shot. I am now facing thousands of dollars in dental work due to bone density loss, and will probably end up with osteoporosis. I am getting off Depo and will never touch it again!

I have experienced some of these side effects-
Low libido, joint pain, bone density loss, dental problems, headaches, fatigue, out of control eating, gained 40 lbs., depression

I hope this information will be useful to others,
Janice Still

5:53 AM  

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