By Liora Engel-Smith
Baby Tyler uttered his first word the other day, and much to Kerry T.’s surprise, that word was “dada.”
“I’m the one taking care of you, not your daddy,” Kerry, 21, who did not want her full name used to protect her privacy, chided the six-month-old.
Tyler grinned at his mom, flapping his arms this way and that. Kerry, from Maxton, a town of roughly 2,500 less than 20 miles from the South Carolina border, knows that she is lucky. She could have just as easily lost her child to foster care. The drugs she used could have killed him too, she knows.
Kerry got hooked on opioid pills in her late teens. She was almost halfway into her pregnancy, with Tyler, still addicted, when she found out. Learning she was pregnant was a turning point for her, she said, helping her realize that she needed to be sober for her child.
But she had a terrifying thought when she considered getting help.
“Nobody will take my baby away from me,” she said. “I would die. He’s literally the only thing I have.”
It’s a reality that many addicted moms contend with when they consider getting help. Substance misuse was cited as a reason for separating children from their parents in 40 percent of North Carolina foster care cases in fiscal year 2017-18, up from 25 percent a decade ago, data from the state shows.
As of August, almost half of children and teens in the North Carolina foster care system — roughly 4,600 — were there because of parental substance use, including alcohol and drugs, according to data from the state. Of these, more than a thousand were babies, the data shows.
The number of families affected is likely much higher, as the state’s data does not account for informal custody arrangements between family members, said Renee Rader, assistant director for policy and programs at the state Division of Mental Health, Developmental Disabilities and Substance Abuse Services, which is part of the state Department of Health and Human Services.
Kerry had another choice, though. She got a bed at Our House, a Pembroke-based rehabilitation program that allows mothers and their babies to stay together. With a more than 30-year history, Our House is the longest-running program for mothers and children in the state. It is one of only 13 rehabilitation facilities for mothers and their children in the state. Between them, the facilities have 264 beds, most of them in urban centers such as Chapel Hill and Charlotte.
Demand for beds fluctuates, so it’s hard to know if the state’s bed supply for new and expecting moms is enough, but an Oct. 6 snapshot showed that roughly 15 of these beds were open. Approximately 20 mothers and pregnant women in North Carolina were placed on a waiting list for specific facilities across the state, data shows.
Tucked on a side street on the outskirts of downtown Pembroke, a town of roughly 3,000 and the seat of the Lumbee tribe of North Carolina, the nondescript structure that holds Our House can accommodate up to 10 moms and their babies. While the women are the clients and most of the services are geared toward them, the babies also receive medical care there.
Babies born to women who use drugs can develop a dependence on the drugs they were exposed to. Unlike addiction, which has an emotional component, the condition babies experience is purely physical. The condition, termed neonatal abstinence syndrome, is linked to tremors, seizures, sleep problems, poor weight gain and a host of other symptoms. Tyler, for example, spent nine days in the hospital weaning off of opioids, Kerry said, after medical providers noticed he was jerking his legs and sleeping poorly.
Under the soft lights at Our House — which often have a calming effect — babies get screened for developmental delays and receive basic medical care. There’s no day care onsite, so the children attend support groups and counseling with their mothers. To aid their recovery, women whose substance of choice is opioids also receive suboxone or other medications to reduce cravings and prevent an overdose.
“We treat the mind, body and soul,” said program director Shirley Williams.
The women there have two big jobs: learning to care for their children and navigating the rough waters of recovery. As many new mothers know, babies don’t always sleep through the night. The turmoil of addiction, a disease so powerful that it upends people’s lives, coupled with a lack of coping skills could easily push even the most motivated of new moms to the brink.
Throughout their stay, which can last months or more than a year, women develop the confidence to care for themselves and their children, even when things don’t go as planned. That’s how Kerry discovered a powerful motivator to get her through the rough patches with Tyler.
“I [don’t] want him to grow up and look at me and be like ‘you picked drugs over me,’” she said. “You don’t love me, you love drugs, and that would be devastating.’”
A critical window
Pregnancy can be a powerful motivator for recovery, Williams said, but it can also be a deterrent. Mothers who use drugs experience the additional stigma of potentially harming their babies. Pregnant women who use drugs can also find themselves criminally charged for child neglect or even murder.
In June, the General Assembly passed a bill that would have defined drug use during pregnancy, regardless of the impact on the infant, as child abuse. The bill failed after Gov. Roy Cooper vetoed it. The state senate attempted to pass a similar bill in 2015, but it died in committee.
Such bills, on top of stigma, advocates worry, can deter women from seeking help. Kerry, for her part, said the thought of losing her child to foster care did cross her mind, but she worried more about inadvertently killing her baby. It was fear for his welfare that prompted her to seek help.
At the same time, North Carolina covers opioid treatment for expecting mothers under a Medicaid rule that offers temporary coverage during pregnancy and up to 60 days after delivery, removing some cost barriers on low-income women seeking recovery.
The existence of this rule goes beyond helping individual women. Medicaid only covers medical treatment — not room and board — but that revenue stream has allowed programs such as Our House to have a stable source of income, said Rader, of the state health department. Programs can also cover room and board through flow-through state and federal funds.
The best outcome of all, Rader said, is finding a way to keep mothers and children together, with comprehensive interventions, such as parenting assistance and medical care, as early in the process as possible.
“We know that children entering the foster care system experience trauma,” she said. “That separation from the family members has a lasting impact on children.”
But addiction doesn’t always resolve after one episode in rehab. An estimated 40 to 60 percent of people with substance use disorders relapse after treatment, data from the Federal National Institute on Drug Abuse shows.
As China D., another resident at Our House knows first hand, recovery is rarely linear or predictable.
Putting the pieces together
In her softly lit bedroom at Our House, China D. inspects the fragments of her life. A grainy photo of her mom, who died this summer, is on the vanity. On the floor near the window is a preschool graduation photo of her now 7-year-old son, who is growing up with his father.
She didn’t get help that first time, she said, and she used drugs for a good portion of her pregnancy. But when China found out she was pregnant, she weaned herself off of drugs on her own.
She didn’t get help for her addiction until a couple of years later when she and her son attended Grace Court, a sister rehabilitation program in Lumberton that also accommodates mothers and children through the recovery process. China said she was sober for roughly a year before the death of her mom started a journey that ended in relapse.
The 27-year-old, who asked that her full name not be used to protect her family’s privacy, tears up when she looks at the framed photo of her smiling child. She touches her swelling belly. China wants this time to be different.
Like many people who use substances, China did not discover her pregnancy right away. She did not go to prenatal appointments or get ultrasounds, blood tests or any of the other medical monitoring that are the standard of care for pregnant women. Her other medical needs went unaddressed too. What she did have was the haze of drugs — cocaine and opiates, a habit that she picked up from loved ones.
Finding out she was pregnant again had rekindled her desire to do better for her children. That’s how the Pembroke resident landed at Our House, where she’s been for the past month or so. Balancing recovery and motherhood, she said.
“It’s very hard,” she said. “I struggle daily. I do my work here and I pray and that’s my strength. I struggle with it every day. It’s very hard to deal with addiction. And being away from my family, it’s very hard.”
China, who had a heart attack the doctors attributed to IV drug use in 2015, recently discovered that she has a leaky heart valve that would require surgery after her child is born. Getting the medical and emotional support she needs, she said, makes a difference.
Near the photo of her son, a pumpkin China painted displays the goal she’s working toward: “2020,” it says in angled, neon lettering. “A different chance at life!”
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Unfortunately, there is little to no mention of alcohol abuse during pregnancy which is the leading cause of intellectual and developmental disabilities. Drugs are hard on fetuses, but have no where near the affect of alcohol in utero. This affects 1 in 20 in the US per May et al, UNC, Lancet, 2018