Arrested, pregnant, hooked on heroin: She got help, but many Louisiana mothers do not

BOGALUSA — At her first pregnancy appointment, Rachel Hernandez showed up in handcuffs, flanked by two sheriff’s deputies.

She had come from a jail cell. Addicted to heroin, facing drug charges and a dangerous path to giving birth, Hernandez was about to get help — a rarity for women like her in Louisiana.

Dr. Ronak Shah greeted her at Our Lady of the Angels clinic without judgment. He outlined a careful course of action to wean her off street drugs and suppress her withdrawal symptoms while protecting her unborn child.

“People hadn’t treated me like that in a long time,” said Hernandez, now 28.

Few addicted mothers in Louisiana receive such care. The opioid epidemic is contributing to the state’s crisis of infant and maternal mortality like never before.

Nearly 400 babies were admitted to hospitals for neonatal opioid withdrawal syndrome in 2021, the most recently available state data shows. Over the past two decades, the number of newborns testing positive for drugs or alcohol exposure has gone up eightfold, according to the state Department of Children and Family Services.

At the St. Tammany Parish jail, Hernandez was one of five pregnant women. At least three of them had used drugs, and she estimated that half of the female prison population there had problems with drug use.

The top cause of death now for pregnant women in Louisiana is accidental overdose.

But little is being done about it.

“The statistics are bone-chilling to hear about overdose in pregnancy,” said Katherine Hebert, a Lafayette-based perinatal mental health specialist and licensed clinical social worker. “That’s something we don’t talk about enough and it’s absolutely a component in mothers struggling, babies struggling and mortality. And these mothers need support for sure.”

Drug usage during pregnancy is linked with higher rates of preterm birth and low birth weight babies — the two leading causes of infant death in the state. And infants here die from those conditions 65% more often than those in the rest of the country.

Drug use in pregnancy is also a risk factor for sudden unexplained infant death, or SUID. Louisiana has the fourth-highest rate of such deaths in the country, according to the CDC.

The program in Bogalusa is a rarity as many rural parts of the state lack obstetricians, let alone specialized pregnancy care combined with addiction treatment. It’s particularly hard to find such treatment in north Louisiana, where maternity care deserts are more prevalent.

“We don’t always truly understand the day-to-day struggles that often these patients are dealing with,” Shah said. “These patients are always so grateful, they’re so thankful, oftentimes, they feel like they’re not given the chance to have adequate care because they live in rural Louisiana.”

Chasing a high

Hernandez moved from her hometown of Chalmette to New Mexico when she was 18. Her boyfriend there asked if she wanted to smoke a concentrated form of marijuana, and she agreed.

But after several days of smoking together, her boyfriend confessed it wasn’t marijuana. It was heroin in tar form.

Hernandez was already hooked. She moved back to Louisiana a year later, where she continued to seek out heroin.

She tried several times to detox and went to rehab twice, but none of it stuck. By 2020, she was homeless. She had wrecked her relationship with her family, she didn’t have a cellphone and she had been arrested several times.

“I didn’t even remember what it was like to wake up and just go,” she said.

When she found out she was pregnant, her friends warned her that if she confessed to a doctor that she used drugs, child welfare officials would take her baby. She knew from her past attempts at rehab that Subutex or a similar drug, Suboxone, could suppress withdrawal symptoms, and she looked for them on the street.

Her attempts to get those drugs eventually led to her arrest.

A friend of Hernandez’ talked her into scheduling a doctor’s appointment. But the friend was communicating with Hernandez’s mom, and the two hatched a plan for police to arrest Hernandez at the clinic, hoping she’d be forced to stop using drugs in jail.

She was arrested for possession of the Subutex she’d bought on the street without a prescription, along with unauthorized use of a motor vehicle for stealing her sister’s car.

Finding treatment in Louisiana to manage withdrawal

The first time Shah met Hernandez, he greeted her with a smile so big that it peeked out from under his mask.

As he performed her first ultrasound and announced she was having a girl, two sheriff’s deputies were in the room. Prenatal appointments were a brief respite from her days in lockup — the lights there never went off, but during a particularly long appointment for her gestational diabetes test, they let her turn the lights off and nap at the clinic.

Shah wrote a prescription for Subutex to replace her heroin. Trying to quit cold turkey was too dangerous; the withdrawal could send her unborn baby into distress and even trigger a miscarriage.

While Shah sees many patients who are incarcerated, he said he does not look at the details in their files to see why they were arrested. Over time, as the opioid epidemic has grown increasingly deadly, Shah said patients have become more forthcoming.

“Patients are starting to realize that we’re actually on the same team,” he said. “Our goal is for you not to lose your baby, and the best way to do that is by being upfront and us getting you into the right treatment system so that you will do your best, your baby will do the best, and you’ll go home with your baby.”

That’s the mindset that Woman’s Hospital in Baton Rouge has tried to emphasize with a program they started in 2018 for expecting mothers struggling with addiction. The program, GRACE, has had 383 referrals since its inception. While the majority are from East Baton Rouge, GRACE has also enrolled people from across the state and even from Mississippi.

The state lost more than two dozen pregnant women to overdose between 2017 and 2019, the most recent years with available data.

Our Lady of Angels started its medication-assisted treatment program in 2020 and trains residents on how to treat patients with substance use disorders. Every Thursday, those patients come to the clinic for medicine and to check in.

“If they were a diabetic, you’d start them on diabetes medicine,” said Dr. Jeffrey Mohr, associate director of the Bogalusa residency program. “They have opioid use disorder, start them on the right medicine to help them get healthy.”

Medicaid covers the cost of the treatment through Our Lady of the Angels, while many private substance abuse clinics only accept cash for the cost of Subutex and Suboxone.

Shah said the mindset around treating addiction in pregnancy has changed. In the past, he said physicians felt like they couldn’t do much until the baby was born.

“That’s the complete opposite mindset that we should be having,” Shah said. “These conversations should be starting the second we find out they’re pregnant.”

Eat, sleep, console

Hernandez took a poll of her friends in jail to decide what to name her daughter.

The name Raedynn won out, while her bunkmate suggested Jade for a middle name because jade stones are thought to help with healing.

She bonded out of jail a few weeks before she was expected to go into labor, which not all the pregnant women at the jail were lucky enough to do. Some had to deliver their babies with only sheriff’s deputies and hospital staff in their rooms, Hernandez said. They only got a few days with their newborns before they had to return to jail.

It was a better experience for her: Shah delivered Raedynn Jade on Dec. 11, 2020. She looked healthy.

Still, Hernandez was nervous: she’d complied with her treatment program and her baby looked OK in ultrasounds, but she was still worried about what would happen after she was born. Babies with opioid dependence can be difficult to soothe and can develop problems eating and sleeping.

Raedynn was the first baby to go through a new program at the hospital for newborns with opioid dependence. Drug-exposed newborns often receive morphine drips in their first few days of life as they withdraw. But Our Lady of Angels’ “eat, sleep, console” program focuses on newborns bonding with their mothers and replacing pharmacologic interventions with breastfeeding, swaddling and skin-to-skin contact.

Hernandez packed a bag and moved into the hospital for the next week, calming her daughter while staff kept a close eye on her symptoms.

“The baby knows you from the womb,” said Dr. Raghubir Mangat, a pediatrician who worked with Raedynn when she was an infant. “So the biggest comfort to the baby after she was born was you.”

The idea of family being constantly present to console babies required some adjustment, said Patsy Welch, the nurse manager for the hospital’s labor and delivery unit. Some staffers used to believe that mothers who used drugs during their pregnancies should not be allowed to spend time with their babies after birth. But the mother’s presence can be the best antidote to a baby’s withdrawal symptoms and can help improve their development, she said.

Before the hospital started the program, Welch said she couldn’t recall any mothers known to have used opioids during pregnancy being cleared to bring home their babies. But that has changed.

Welch says that compliance with their program goes a long way with DCFS.

If newborns are affected by substances that their mothers used legally during pregnancy — like mothers compliant with Subutex treatment — physicians notify DCFS, but an agency spokesperson said it will not lead to an investigation. DCFS only investigates if the mother unlawfully used substances during her pregnancy that later affect the newborn, they said.

“We always say, if we could just win one patient, it’ll all be worth it,” Welch said. “But once you get that one, you want to keep winning.”

Still, it’s not always possible to manage withdrawal symptoms in newborns without medication. That’s especially the case for babies who have been exposed to street drugs, like heroin or fentanyl, rather than the closely monitored and prescribed Subutex during pregnancy, the physicians said.

The problems that often lead to drug use do not magically go away once an infant is born. Dr. Akhil Maheshwari, the neonatology division chief for LSU Health Shreveport, said he often worries about discharging babies whose parents are still struggling with addiction. He said society and community need to step up in those instances and figure out what’s driving drug usage.

“It often appears that it is a place of emotional hiding because some of these problems are not easily solvable,” he said.

Raedynn stayed in the hospital for a week before Hernandez took her home. She only needed tiny amounts of morphine before she weaned off and went home, a major success for the start of the program.

The average hospital stay for babies withdrawing from opioids at the hospital used to be six weeks. It’s now down to seven days.

“The star over here is Rachel,” Mangat said. “We were just the facilitators. The work was you.”

Discovering new goals after drug addiction

After she delivered Raedynn, Hernandez tapered down her dose of Subutex. A year later, she was off it entirely.

A judge routed her through drug court, requiring her to attend intensive outpatient treatment and 12-step meetings, and to get a sponsor. She frequently visits rehabs to tell her story and advises health care workers on how they can improve treatment for addicted mothers.

She works waiting tables and bartending in Madisonville and is trying to figure out what she wants to pursue next in life.

“I forgot I had real goals before all of this,” she said.

Hernandez is also trying to figure out how she will explain the story to Raedynn, once she’s old enough. She hopes her daughter won’t be ashamed.

Raedynn, now nearly 3, carries a Rapunzel doll that she calls Elsa and loves making new friends. When she returned to the hospital, Welch, Mangat and the rest of the team showered her with hugs.

“It gives me so much joy,” Mangat said. “When I see those babies thriving.”