By Sarah Colson and Jeff Keeling
Fourth in a series. Our latest story on Neonatal Abstinence Syndrome (NAS) highlights a program at the Johnson City Detention Center. The program’s leader thinks it could help significantly reduce rates of NAS. It also tells the stories of two women whose struggles with drugs have led to incarceration and, in one case, the birth of a child with NAS, and how the program has helped them.
For the first time in their lives, two inmates at Johnson City’s all-female jail are learning what it means to actually take care of themselves for the sake of others. Ashley and Jamie (not their real names) both are mothers, and Ashley’s almost-2-year-old boy, Max, is still suffering from the side effects of Neonatal Abstinence Syndrome (NAS).
“It’s not a good feeling,” Ashley said, explaining with tears in her eyes how it felt to see her newborn in the NICU. “It breaks your heart. There’s no one that wants to do that to a baby.”
Today, Max still does not sleep through the night, gets overstimulated and fussy often, and has tremors—all typical symptoms of NAS.
“I went to jail again, got out, and I got pregnant with Max,” said Ashley, who has been incarcerated several times and also has a 6-year-old son who wasn’t born with NAS. “I didn’t use (drugs) the first eight months. I started using when I was eight months pregnant, pain pills, and I didn’t stop until he was born. They had to start him on morphine and he stayed in the hospital for three weeks. I came to jail after that and he went with my mom.”
Fortunately for Ashley and others determined not to needlessly risk bearing children with NAS, a detention center program provides the opportunity to choose long-acting contraception prior to release. It’s conducted by Dr. Cynthia Thomas, a physician with the Northeast Tennessee Regional Health office who has been on the front lines of the battle against NAS for several years.
First used in Johnson City in the summer of 2014, the program delivers educational sessions about NAS prevention to female inmates. At the conclusion, the women are offered reproductive life planning counseling and voluntary reversible long acting contraceptives (VRLAC) prior to their release.
Although these sessions only last about 45 minutes to an hour, Thomas said this kind of education has the potential to dramatically change NAS rates over time. In fact, it was those alarming NAS rates that prompted her to try the program in the first place after seeing it work in the rural counties outside of Knoxville.
“When we talk about specifically primary prevention,” Thomas said, “the classic example is vaccines. So you’re trying to prevent the problem before it ever happens. With NAS, although we can anticipate when it happens and treat it when it does, it’s completely preventable either by preventing exposure to opioids in women of reproductive capacity or by preventing unintended pregnancy in women who are at risk.”
Based on her colleague’s experience in the East Region, which comprises 15 counties around (but not including) Knox County, Thomas, who works with health departments in seven area counties, knew that partnerships would be vital to make the program happen here.
“One of the things I have tried to do is really develop relationships and partnerships with our community partners,” Thomas said, “our academic partners, our clinical partners, because none of us can do it independently. I have personally learned so much from my partners in the recovery world, in the judicial system, in the corrections systems, that I could not have learned working in isolation.”
She’s learned much from Amy Clark, who has been Johnson City’s detention center administrator for three years. Clark, whose facility stays at its 88-person capacity and houses state inmates only, estimated 100 percent of them have issues with drugs, even those whose arrests didn’t directly involve drug charges.
Clark said about three quarters of inmates are mothers, and for a variety of reasons, many tend to get pregnant again after their releases.
“Inmates leave, and three months later you hear they’re pregnant,” Clark said. “And then they get re-incarcerated, so they’re leaving this newborn baby. The baby might have NAS, or it is just put on society to provide. So we’re looking at two things this program can help with.”
Thomas, who is working with several other jail administrators to broaden the program, said it’s important to have this kind of training when women are sober and recovering in jail.
“It’s a great opportunity to go in and talk to these women at a point in time when they have the ability to listen, to hear, and to implement something that they feel will be in their best interest. I’ve had women say ‘thank you so much for coming here and doing this because I would have never listened to you when I was out on the street.’ And that’s powerful.”
Jamie and Ashley both said they would have never done this kind of training while on the streets. Both of them also said that they now have a better understanding of why they turned to drugs in the first place. That is in part due to additional counseling programs offered inside the jail.
Ashley, who’s serving a five-year, drug-related sentence, said at the end of her pregnancy, her mind was so clouded with drug abuse she could only think of herself.
“I just kept telling myself I had time before I had him,” Ashley said. “I said ‘I have time to quit before I have him.’ And there were a couple people that tried to help me get in rehab and stuff but I just kept telling myself ‘I’ll do it on my own.’ I didn’t want anybody to know about it. Obviously that didn’t work out.”
Jamie’s struggle with addiction began after her daughter was born.
“I had a little girl right after I graduated (high school) in 2008,” Jamie said. “I didn’t start using (drugs) until after I had her. I went through some mild depression with having a baby young and things like that.”
Neither woman plans on having any more kids soon. Both have chosen to pursue family planning appointments and receive some form of birth control after their release.
“I want to be responsible about things and I know having a child is not something I want to do at all anymore, right now anyways,” Jamie said. “I want to make sure I’m going to be there and do what I’m supposed to do first and have my priorities when I get out.”
Ashley has similar goals, and said not having another child is vitally important. Both her children were born via caesarian section and she worries about what a third would mean for her and the baby’s health. Ashley also said her main priority will be getting to know the baby she left in the NICU almost two years ago.
“I’m going to get birth control,” Ashley said, determinedly. “I just have two little babies so I’m going to just keep them. They’re still young so there’s plenty of time for them. No more babies. I’ve got my hands full enough as it is.”
“I’ve distanced myself a lot from Max, too. I don’t ask as much about him. I guess I still feel guilty. I haven’t dealt with that yet. I haven’t dealt with that guilt yet. But I also haven’t been around him either since he’s been born. So I don’t even know him. I know my six year old because I had custody of him. It’s hard. (Max) is almost two and he doesn’t even say any words. So he’s having a hard time talking and stuff.”
Looking ahead, Ashley wants to enroll in culinary school when she gets out. And thanks to her training, Ashley also hopes to experience one task she’s never before had.
“I can’t wait to pay bills,” she said. “I can’t. I just can’t wait to have my own bill. I’ve never had a bill in my name and I can’t wait to have that. I want to learn how to live on my own.”
Clark said the two women and others she has trained have learned a lot and are much better prepared to transition to life on the outside.
“They’ve grown independently versus relying on other people to take care of them,” she said. “They’ve done some soul-searching on their own and kind of found out who they want to be by themselves. First they need to find out who they are and then secondly they want to be there for their kids. Now they’re looking at the big picture and learning how they can grow and improve and be successful law-abiding citizens.”
Thomas said she thinks this program will eventually cause a “tremendous” decrease in the numbers of NAS cases reported annually within the state.
“We’re hopeful,” she said. “We’re cautiously optimistic that we’re making a difference, that we’re raising awareness and that the downstream consequence of raising awareness is that more people are taking advantage of opportunities to put these prevention efforts into place… I don’t’ think we’re going to see an all-at-once impact. We’re going to see an impact over time; it’s not going to be immediate. But I think that we’re going to see increased awareness. We already are.”