I write about addiction being a disease in order to counter the negative stigma that society holds for those who, through little fault of their own, were captured by opioid dependence.  One of the most potent examples of this stigma is the attitude toward addicted mothers on the labor and delivery ward from doctors, nurses, and family members of an addict who is a new mother.

News stories, movies, and public service announcements have implanted images in our minds of babies in opioid withdrawal, suffering horribly because of their mothers’ bad habits.

I was a part of the world of obstetric suites, newborns, and labor epidurals during my ten years as an anesthesiologist.  During that time I met many new babies, and I became pretty familiar with the experiences they endured in their first few hours in the hospital.  I like babies—my wife has had a few who I’ve become quite fond of—and so I don’t mean to sound unsympathetic toward them.  But the images that most people have of babies craving a ‘fix’ are not accurate—not by a long shot.

I don’t know with certainty the actual subjective experience of a newborn.  But I cannot imagine a newborn having the neural cortical connections required to experience anything akin to the ‘cravings’ experienced by opiate addicts, which consist of memories of using associated with emotions, or drives created by the positive reinforcement of behavior—aspects of the life of an addict that are NOT part of the experience ‘in utero.’

Realize, too, that the withdrawal experienced by addicts consists of little actual ‘pain’ (I’ve been there—I know). Addicts will even ask each other ‘why do we hate withdrawal so much?’ It is not physical pain that makes it terrible, but rather the involuntary movements of limbs, the depression, and the severe shame and guilt that characterize opioid withdrawal.

A normal newborn has the same spastic, involuntary movements– as the result of incomplete myelination of spinal nerve tracts, immature basal ganglia, and uncoordinated cerebellar function. And the worst parts of withdrawal, i.e. shame and guilt, are not experienced at all by babies—since they have no awareness of the stigma of addiction!

Finally, if we are to worry about the misery experienced by withdrawing newborns, we should compare their lot to the misery experienced by newborns in general.  For example, what must it feel like to have one’s head squeezed so hard that it changes shape?!  Yet nobody seems sympathetic about that discomfort, at least from the baby’s perspective. I expect it also hurts to have one’s head squeezed by a pair of forceps, not to mention being pulled by one’s head through the birth canal!

For many newborns, the misery is just starting.  Many hospitals still do circumcisions without local anesthesia, instead tying down the baby’s limbs and cutting with a scissors—or worse, strangulating off the offending tissue with a piece of string (ouch!). Babies needing surgery for pyloric stenosis are often intubated ‘awake’– which anyone who understands intubation knows is not a pleasant experience. Until a couple decades ago, babies underwent surgery on the heart–including splitting the sternum or breaking ribs– with only a paralyzing agent, for fear that babies wouldn’t tolerate narcotics or anesthesia.

It is unfortunate that some of the babies of moms on opioids experience the heightened autonomic activity associated with neonatal abstinence syndrome.  But compared to other aspects of the birth experience, I know which I would choose!

My comments are not meant to encourage more births of opioid-dependent babies. But anyone in a position to elicit shame should remember that the cycle of addiction and shame is well-established, and there is already plenty of shame inside most addicted moms.  Any mom/addict will attest that If there are ten babies screaming loudly, only the whimper from the ‘addict baby’ elicits the ‘tsk tsk’ of the nurses and breast feeding consultants. I have no doubt that such bias leads to inappropriate morphine infusions, NICU stays, and even social service referrals; I am certain because I’ve witnessed all three in my patients alone!

My own first child was born to a healthy mother years before my own opioid dependence, yet he never took to breast feeding.  Had his mother been an addict, his trouble surely would have been blamed on ‘neonatal abstinence syndrome!’

Unfortunately even caring professionals often see what they want to see; sometimes their view needs to be checked for bias and undeserved stigma, for everyone’s good– baby included. And if you are one of the new moms torturing yourself for hurting your baby, consider cutting yourself a little slack. Focus on the right things going forward, and do all that you can to avoid returning to active addiction. That, more than anything, will make you a good mom.