Nobody assigned it. I read a quote in a Newsweek story from Ira Chasnoff, at Northwestern's perinatal dependency clinic, and thought, "That's right here!" One benefit of not having a job is that nobody expected the story, and I could work on it as long as I liked. I worked on it a lot. I remember standing at the clinic, on the phone, negotiating with my addict to make her clinic appointment. She wanted me to pay the cab, which is not a no-brainer when you are an unemployed 25-year-old writing a story on spec.
What strikes me now is that is the story 2780 words long, or almost the length of four columns. If the world were coming to an end, the main story on the meteor bearing down on us wouldn't be 2780 words long. But I am in the Upper Peninsula of Michigan today, staring at the flat line of Lake Superior, so this will have to do. I hope it holds your attention.
Last May 9, Delores Dorsett got together with friends to freebase cocaine. For about an hour they passed around a small glass pipe until they had smoked 2 grams of cocaine, for which they had paid $110.
The evening was typical for the 30-year-old Dorsett, who had been doing drugs since she was 16. In fact, the only difference that night was that Delores Dorsett was six months pregnant with her seventh child, and after inhaling the cocaine, she began experiencing cramps and abdominal pain.
So, on May 11 — Mother's Day — Dorsett went to Northwestern Memorial Hospital's Prentice Center for Women, where she had been participating in a program for chemically dependent mothers. At first, her doctor planned to administer Ritodrine, a drug that stops contractions and delays labor. But Dorsett was too far along by the time she arrived at the hospital. Nothing could be done to prevent the delivery. At 7:34 a.m. the next day she gave birth to her fourth daughter, Leanna. The newborn was Dorsett's second child affected by cocaine use, and one of the 100 or so "cocaine babies" delivered in the past year at Northwestern Memorial.
Leanna suffered from several problems frequently found in cocaine babies. Premature and underweight (1 pound, 13 ounces at birth), she had a clubfoot, deformed genitalia (doctors had to analyze her chromosomes to determine she was female) and other problems that required a colostomy, which was performed the day after her birth. At the same time, the traces of cocaine that had been detected in her blood at birth began to dissipate, and several days later Leanna went into cocaine withdrawal.
And Leanna was lucky. Because Delores Dorsett had been in Northwestern's in-patient treatment program, at least 21 days of her pregnancy were drug free. Doctors were ready to respond to Leanna's difficult birth, and afterward her development could be monitored by the handful of doctors in Chicago intimately familiar with cocaine's ravaging effects on newborns.
Most cocaine babies are born to women who have received no drug treatment, or even regular prenatal care, according to Chicago drug professionals.
"We get more and more calls," said Dr. Ira Chasnoff, director of Northwestern's Perinatal Center for Chemical Dependence, "from different hospitals saying, `We've just had a mother give birth, and the baby's terrible, and we found out the mother was on cocaine. What do we do?' "
The Northwestern program was begun 10 years ago to treat female heroin addicts and their babies. Cocaine babies were unheard of then. But within the past three years there has been a radical shift in the patterns of drug use in the streets. Today 80 percent of the women in Northwestern's perinatal program are primarily cocaine addicts.
There are no statistics available to determine how many cocaine babies are born in Chicago. One doctor at Northwestern estimated that hospital sees half of the cocaine babies born in the city, while another suggested it sees only 2 percent.
Whatever the number of cocaine births, there are indications they are rising. Not only do programs such as Northwestern's universally report huge increases in the number of cocaine addicts seen, but figures associated with cocaine — emergency room visits and deaths attributed to cocaine, for example — have shot up.
The closest to a hard statistic on general incidence of cocaine births is kept by the Illinois Department of Children and Family Services. By law, cocaine babies have to be reported to the DCFS, which is supposed to investigate the family situations. Reports given to DCFS are lumped under the agency's "substance misuse" category, along with those of parents who give drugs to their children. Substance misuse reports for Illinois jumped 27 percent to 423 in fiscal 1986, a rise DCFS attributed primarily to an increase in reports of drug-affected newborns. And hospitals only report children who have cocaine in their bloodstreams when born, so not all babies influenced by cocaine are reported.
While Northwestern's program is the only one in the Chicago area devoted to addicted mothers and their infants, cocaine babies also are born to women in various drug and perinatal programs scattered around the city.
Substance Abuse Services Inc., a network of drug-treatment facilities, has approximately 100 women who are pregnant or new mothers or who have recently miscarried participating in its programs. Michael Reese Hospital places cocaine-addicted pregnant women into its high risk obstetrics-gynecology program, where the emphasis is on their pregnancy, not their drug addiction. For each pregnant woman receiving treatment, many more women — some estimates say as many as 100 others — never seek help for their cocaine addiction, or special treatment for their cocaine-affected babies. "We don't see a lot of these people because they die before they get to us, and that includes children too," said the director of a large drug treatment program.
Many factors conspire to keep pregnant women from seeking treatment for cocaine abuse: cocaine's effect on developing fetuses is not widely known; addiction to the drug is very difficult to treat, almost requiring hospitalization for any hope of success; women face particular hurdles, and undergo personality changes. Finally, not enough treatment programs in the city are geared toward either cocaine addicts in general or pregnant women in particular.
Research on cocaine babies is itself in its infancy. The first medical paper on the subject, Chasnoff's "Cocaine Use in Pregnancy," was published in the New England Journal of Medicine only a year ago. While some basic questions — the effect of dosage and frequency of use on the fetus, the exact risk of deformity, the length of time cocaine stays in the baby's system — have not been answered, doctors are piecing together a picture of cocaine's impact on fetuses and infants.
The stage of pregnancy when cocaine is taken is extremely important. The first and third trimesters are the most dangerous times to use cocaine, experts say.
In the first trimester of pregnancy, cocaine can affect the development of the fetus. Cocaine constricts the blood vessels in the placenta, cutting the flow of nutrients and oxygen to the fetus, risking stillbirth and retarded development. The fetus's blood vessels also contract, causing deformities, particularly of the heart, lungs, digestive system and genital tracts. Increased blood pressure also means that fetuses are susceptible to suffering strokes in the womb.
Cocaine use in the third trimester of pregnancy can affect the delivery. Doctors have found that cocaine addicts have a very high rate of abruptio placenta — premature separation of the placenta from the wall of the uterus — that can cause both mother and child to bleed to death. As in Leanna's case, premature labor frequently is a problem and once born, cocaine babies have slowed developmental responses and a higher rate of sudden infant death syndrome.
Cocaine does not "cause" these problems in the same way that thalidomide caused defects in children born to pregnant women who took the sedative in the early 1960s. Rather, cocaine greatly increases the odds that these defects will occur. Doctors haven't seen enough cocaine babies to develop statistics, but a current estimate is that women who use cocaine have at least five times as many defective babies as non-user mothers. And, just as using cocaine one time may cause death in an adult, so a single cocaine use can affect an infant's development or cause miscarriage. Doctors say it is not uncommon for a woman to go into labor and deliver immediately after using cocaine.
One problem found in most cocaine babies is withdrawal — a nervous, jumpy, tremulous state that affects 90 percent of cocaine babies. While withdrawal is physically temporary, it can cause long-term developmental problems. Babies in withdrawal are so irritable that a touch can set off spasms and crying. Their mothers tend to hold and nurture them less because of this, and lack of maternal contact hampers normal psychological development of the child. Thus an important part of treating mothers of cocaine babies is to teach them parenting skills and ways to calm the baby, such as swaddling.
Ignorance of the risks does not fully explain why cocaine-addicted women don't seek help. Cocaine — once considered a relatively benign drug of the rich — recently has been revealed as one of the most addictive drugs known, a "cunning and powerful, insane disease," according to one therapist.
Not only is it addictive, but addiction to cocaine is very difficult to conquer — one survey showed that 90 percent of cocaine addicts who become cocaine-free through treatment become addicts again.
It is not uncommon for women in cocaine treatment programs to deny the medical facts when presented to them. A woman who had been through inpatient treatment programs at Northwestern and Weiss Memorial Hospital described her addiction this way:
"I just wanted to do it, so I did it. Cocaine is a selfish drug. You might have your last $30, and you might have bills to pay, but you go out and spend it on cocaine. You really don't care. I knew I was pregnant. I knew the consequences. I'm a nurse. I work in a hospital. When you have that urge you really don't care. You do it."
Drug counselors often compare giving up cocaine to the death of a loved one. Cocaine addicts trying to give up the drug go through all of the stages normally associated with grief — denial, bargaining, anger. Often that anger is directed toward the new baby, who is blamed for the trial of treatment and the inevitable depression that follows giving up cocaine.
Not only do women fail to seek help because of the powerful grip of the drug, but the lifestyle that the drug almost always demands makes breaking addiction very difficult. People who use drugs gravitate together, addicts surrounding themselves with other addicts, who encourage their habits.
Most women in Northwestern's program are on public aid, and to pay for their addiction they sometimes turn to prostitution, theft and drug dealing, pursuits that in themselves are not easily abandoned once begun.
And finally, for women who manage to overcome all these obstacles to treatment, there is one more: treatment is not always easy to find. Pregnant women are in a double bind — they must find a program that accepts both their pregnancy and their cocaine addiction. This is not a simple task.
For example, the Garfield Women's Center is a state-run drug treatment facility with a program that can serve 90 women at a time. It accepts pregnant women — seven babies were born to patients last year. But, the methadone maintenance program does not accept cocaine addicts.
"Heroin was the primary drug of choice and now it is cocaine," said Jackie Freeney, director at Garfield. Freeney said that despite the shift, Garfield is not allowed to take in cocaine addicts because of funding restrictions. According to Freeney, a handful of cocaine addicts — no more than three at a time — are slipped into the program.
"We get calls every day (from women addicted to cocaine) — there's no place to refer these women and the places that do take them have extensive waiting lists," said Freeney. "There need to be more programs designed to meet just the needs of the cocaine abuser."
On the other hand, the Gateway Foundation, one of the largest drug treatment programs in the state, accepts cocaine addicts. Since 1983, the number of cocaine addicts treated at Gateway has quadrupled.
But it doesn't accept pregnant women, an "unfortunate reality," according to a Gateway director, who said that of the 2,000 patients treated there last year, only one was pregnant. The foundation simply cannot meet the medical needs of a pregnant addict.
It is a cliche that public programs are inadequate to handle the problems presented to them. But that doesn't diminish the fact that, due to the overcrowding and waiting lists, people — particularly pregnant women — seek out help and are turned away.
"The thing is being able to respond to a person when a person really wants to come in," said Chuck Corley, a counselor at Substance Abuse Services Inc. "When a person makes up their mind, you have to be ready, and if you're not ready, they slip back into drugs. In our case, what happens, the majority of the time, is by the time we get a pregnant woman (into our program), she's going into second or third trimester, and we'd like to get them in much earlier."
Private groups certainly have sprung up to meet the need. Due to demand, Weiss Memorial Hospital has had to triple the size of Lifeline — its rehabilitation program for cocaine addicts — since it began in January, 1985 Lifeline now sees more than 500 patients a year. Many private hospitals have substance abuse programs, along with facilities to handle pregnant women.
For example, Northwestern Memorial has a well-rounded program for pregnant cocaine addicts, with an inpatient program to help keep the mother off drugs, expert physicians in the field and clinics that track the child's development. Northwestern has no waiting list and is ready to accept new patients —at $600 a day, or $13,000 for the 21-day inpatient program. The assessment interview alone costs $60.
While medical insurance or public aid can cover most or all of the expenses, approximately half of the women in Chicago could not afford a private drug treatment program such as Northwestern's, either because they don't qualify for public aid and don't have insurance, or because they have insurance that doesn't cover drug treatment or that carries deductibles.
"Previously, people who used cocaine had significantly high financial resources — if they could afford the drug, they could afford the treatment," said Dr. Richard Sherman, head of Chicago's Alcoholic Treatment Program, who cited a reduction in the cost of cocaine as a major factor contributing to the problem of treatment. "Now we're seeing people who've gotten into trouble and can't afford a hospital stay. A lot of these people who don't get into private hospital programs don't get treated. There is a real need for residential treatment programs in the city."
Every Friday from 9 a.m. to 11 a.m., Northwestern Memorial has a clinic for cocaine babies. The waiting room is crowded with women holding infants. In one examination room Dr. Chasnoff is testing a 4-day-old infant for withdrawal — he pumps on the baby's arms and releases, and the baby cries a choppy, rasped cry, hands reaching out spasmodically, trembling.
"Cocaine babies tend to be very jittery, especially when lying nude," Chasnoff says. "They lose their boundaries."
In the next room, Dr. Dan Griffith, a psychologist, puts a month-old boy through a series of developmental tests.
"OK, let's check out your reflexes, big guy," he coos, running a finger over each tiny foot. Griffith is a large man who played off-tackle at Wabash College in Indiana, and it is a little surprising to see how tenderly he handles the baby.
"How's that grip" he asks, wrapping the baby's fist around his finger. "Oh good." He holds the baby up and tries to get him to take a step.
"Let's try some flying," he says, holding the baby out at arm's length and sweeping him through an arc. Griffith keeps up a running conversation with the baby, supplying his own responses. "Let's see how your eyes work. They work pretty well. You're supposed to turn your head. Right."
Griffith plants himself in a chair, holding the baby in front of him. "You're looking for me. Whoop! You found me!"
He holds his face inches from the baby's. "Hi big guy!"
The next patient is Leanna Dorsett, discharged from Northwestern just two weeks before. At three months of age, she weighs 5 pounds, 6 ounces — underweight for a newborn. Her eyes are milky and huge. With Leanna is her mother, Delores Dorsett, who prepared for her arrival home from the hospital the same way she prepared for her birth, by using cocaine.
The colostomy bag is irritating Leanna's skin, and Chasnoff shows Dorsett how to apply the bag properly. Dorsett asks if her baby is still suffering from withdrawal.
"Well, with babies this premature it's hard to tell," Chasnoff says. "She's a little shaky, but I can't tell if it's withdrawal or prematurity."
Someone asks whether the colostomy bag is permanent, and Chasnoff says that corrective surgery will be done as soon as Leanna weighs 20 pounds.
"Her big sister is 2 and hasn't got to 20 pounds yet," whispers psychologist Diane April, referring to Shanetta Dorsett, who was born with lung and heart defects. "So she may have to wait awhile."
The examination ends and Dorsett dresses her daughter in a light purple jumpsuit. Chasnoff, about to walk out to the other examining room to see another baby, consults his clipboard. "I need to see her next week," he says to Delores Dorsett. "She comes to term next week." He smiles. "It's her birthday."
—Originally published in the Sun-Times, Oct 12, 1986.
If you haven't read enough, and are curious as what happened to Leanna Dorsett, I followed up in 2000. Read it with a tissue.