I. Motherhood and Addiction
Taneisha China watched her 8-year-old son, Andrew, draw a picture of a house with a front lawn and a car parked in the driveway.
“He’s so good, and I was getting emotional,” said China, 33, of West Philadelphia. “I said, ‘Andrew, you really drew that?’ He’s like, ‘Yes, mommy because we are going to have our house one day.’’
“So that meant a lot to me, that he thought of us moving into our house,” she added. “And that’s my dream, to have our house, and be sober and clean through recovery.”
China has been living at Family House NOW, a residential treatment center in West Philadelphia for pregnant women and mothers with children ages 13 and under, for about four months. The treatment center is one of about 10 treatment programs in the Philadelphia area that allows mothers with substance use disorder to bring their children with them.
These kinds of facilities are an important resource for mothers with addiction, who face additional barriers to getting into treatment and recovery.
“That they have programs like this is very helpful and it’s beneficial because you learn how to be a parent again,” China said. “And you don’t have to feel the shame.”
Mothers are often the parent who take on the bulk of childcare responsibilities, and thus, must worry about where their children will go if they decide to seek treatment.
Pregnant women face even more difficulty in seeking recovery. They may be too afraid to ask others for help at all, due to fear of judgment about their drug use during pregnancy.
This fear can have negative health consequences for infants, too, who may be born dependent on the drugs their mother used.
II. Pregnancy and Treating Dependence
In Southeastern Pennsylvania, the number of infants exposed to “illegal drugs” in the womb has increased by nearly 30 percent in the past few years, according to a report from the Pennsylvania Department of Health that compares 2016 data to the same type of data from 2013.
In Philadelphia alone, the number jumped by about 8 percent within the same time period, though that percentage is likely higher because Temple University Hospital and Thomas Jefferson University Hospital did not report any data.
Many of these newborns suffered from neonatal abstinence syndrome, experiencing fever, vomiting and uncontrollable shaking, in addition to excessive crying and not eating or sleeping properly.
“If there is in-utero exposure of the baby during pregnancy to opioids, when that umbilical cord gets cut, the infant will suffer signs of withdrawal,” said Dr. Walter Kraft, director of the clinical research unit and division of clinical pharmacology at Jefferson.
“The way that I think about it for the infants is like a bell curve,” Kraft added. “Some infants have very few signs of withdraw, some have a lot.”
Infants with NAS are most often treated with morphine and stay in the hospital for about a month. However, Kraft led a study published in May 2017 that found buprenorphine, commonly known as Suboxone, can cut the length of treatment in half. Kraft said this can be important for allowing mothers and their infants to bond.
“If we can reduce the time away from home, I think we are going to strengthen that bond,” Kraft added.
When Colleen Peebles, 34, of North Philadelphia had her daughter Niahlá in September 2017, she was born with NAS and experienced shaking, crying and diarrhea. Niahlá had to stay in the hospital for two months and one week, Peebles said.
“The same thing I would go through when I would withdraw, she would go through, and I know how it feels for me, but imagine how it feels for a baby who’s so innocent,” Peebles said. “She can’t help herself.”
However, the effects of NAS can be lessened for mothers who use medication-assisted treatment during pregnancy.
Methadone and buprenorphine are two MAT options that have been shown to improve maternal and neonatal health.
Dr. Laura Hart is the medical director of the Temple Wedge Opioid (TWO) Treatment Program, which treats pregnant women with opioid use disorder. She said there are pros and cons to both medications.
“We do know that women who are exposed to [buprenorphine] versus methadone have less severe NAS, less days in the NICU for babies,” Hart said. “But it is a fairly new medication, so not everyone has sort of gotten on board.”
“It’s not for everyone,” Hart added. “Methadone is very rigid, you have to go every day to get your medication and some women really need that structure in their life.”
III. Treating New Moms
Peebles began taking buprenorphine during her pregnancy to treat her addiction to opioids.
She learned about MAT options while going through Mothers MATTER, an outpatient program for pregnant and post-partum women with opioid use disorder, based out of the Hospital of the University of Pennsylvania’s Helen O. Dickens Center for Women.
Hannah Gross-Eskin is the interdisciplinary care coordinator for the program, which has existed for about a year. The program also offers methadone as a treatment option.
“A lot of what we do is educating about medication-assisted treatment because there’s a lot of misinformation about it,” Gross-Eskin said, adding it’s not good for pregnant women to go into detox, or to stop their drug use without medication. “What the buprenorphine does is keep a stable environment for the mom to be able to carry the pregnancy to term without complications, to keep a stable environment for the fetus.”
Mothers enrolled in the program come in once a week to receive their medication and for one-on-one therapy.
Mothers MATTER has a four-member staff, which allows them to provide specialized attention to the estimated 20 women in the program. Gross-Eskin said she often takes calls from mothers on her cell phone at any time of day.
“I feel like I know them all really well,” Gross-Eskin said. “I feel like that’s what they appreciate most, they feel like they get really individualized attention and we’re there to support them without judgment.”
Peebles was hesitant to go to Mothers MATTER at first because she didn’t want to be judged, she said. But Peebles said she didn’t have that experience.
“They made me very comfortable,” Peebles said. “They worked on my pace. They didn’t make me say or do anything I didn’t want to do.”
“Every time that I go there they are always saying how proud that they are of me,” she added.
IV. Mothers Recover Together
Bishop Dionne Butts, a therapist at Family House NOW, said the women at the treatment center bond over their shared struggles and become a “pack of moms watching over their children” together.
China said the benefits of living with other women outweigh any negatives.
“It becomes sometimes tense because with a bunch of women it could be catty sometimes, but we still come to each other at the end and apologize if we’re wrong and at the end of the day we’re here for a reason,” China said. “We become close, we become recovery sisters.”
China added she didn’t even realize treatment centers existed for mothers and their children until she found Family House NOW.
To live at the residence, mothers must complete an assessment and qualify for care through Community Behavioral Health, a nonprofit contracted by the City of Philadelphia to provide mental health and substance use disorder services to people receiving Medicaid. Another requirement is that women have a co-occuring mental health disorder and are currently seeking treatment for it. Butts said there are 11 women currently in the program and most stay for about six months.
Ashley Rosenberg, 30, of Northeast Philadelphia, has been at Family House NOW for the past two months. She is pregnant and due in October with her first child.
“I thought that when I got pregnant that would be motivation enough for me to stop drinking or using,” she said. “But it wasn’t. I guess I didn’t realize that just that fact wasn’t enough motivation, like it was out of my control. I really couldn’t stop.”
Rosenberg said since being in the treatment center she’s enjoyed individual counseling to help her deal with the emotions that come with pregnancy. She added she enjoys being around the other mothers and their children in the residence.
“It is helpful to be around other people with their children to kind of learn how to parent because I have no other experience with kids,” she said.
Butts said there are classes for residents to help them prepare to be better parents once they leave the facility. Childcare is offered so residents can attend classes.
“It’s assumed that our participants do not have the skills to parent correctly, to budget correctly, to live a life free from addiction,” Butts said. “So while they’re here in treatment they’re learning.”
China said the parenting classes have been helpful as she rebuilds her relationship with her son, Andrew. Monday through Thursday, participants also attend a “Mommy and Baby” session where they interact with their children by playing games or other activities.
“I’m doing homework with him, we’re doing activities together, I’m talking to him,” China said. “And he’s like, ‘I’m just so proud of you mommy that you’re doing things with me, and I love you mommy.’ And that means so much to me because before when I was out there I didn’t care.”
V. Working Toward Long-Term Recovery
Every Wednesday night Megan McAllister leads a 12-step group of about 30-40 people at St. Mark’s Church in Frankford for people who are using medication-assisted treatment. The group, Medication-Assisted Recovery Anonymous, is composed mainly of women, many of them mothers, McAllister said.
“[The] majority of them don’t have custody of their kids and that’s usually people in early recovery or people that are fighting for their kids,” she said. “I feel very badly because I know what it’s like to be a mother and choose drugs over your kid. It doesn’t mean that you love them any less, but that disease is in your head and you’re like a different person.”
McAllister herself is a mother in recovery. She has two children, Gavin, 9, and Emalyn, 3.
She added that she’s open with her children about her past addiction and her recovery. Her son Gavin knows she takes methadone.
“He knows that I’m on medicine now that helps me not do drugs or drink,” she said. “He comes with me sometimes to go get dosed and he’s like, ‘Don’t forget to get dosed, mommy,’ He knows that I used to act silly and be crazy.”
For mothers in the early months or years of recovery, MAT can help them find stability while raising their children. MAT is the most effective option to treat opioid use disorder, according to The Pew Charitable Trusts.
Mary Jane Stein, 44, of Bridesburg has been in recovery for about eight months. She also takes methadone as part of her recovery. She said it’s helped her with cravings and improved her mood.
Stein is preparing to marry her boyfriend, Rob, in August. His daughter Bailey, 10, lives with the couple. Bailey’s mother died of an overdose. Stein talks to Bailey about her recovery and use of MAT.
“She said to Rob, ‘You know, it’s so good to see Mary normal again,’” Stein said. “She knows because she watched her mother. It’s just good to see a smile on the kid’s face, knowing that it’s not going to happen to her dad’s girlfriend.”
Stein’s past drug use, however, caused tension with her son, who is now 26. They haven’t spoken for two years. Most of Stein’s struggles with drugs came during her son’s high school years, she said.
“For him to be as angry as he is with me today, I know he knew,” she said. “We try and say, ‘We don’t do it around them,’ or, ‘They never see nothing.’ I know how angry he is at me. He saw more than I thought.”
For other mothers in recovery or working toward it, McAllister said they should keep trying their best.
“They need to know that no mother is perfect,” she said. “As long as you’re trying, you deserve a chance.”