Why Some Tennessee Women Are Afraid To Give Birth At The Hospital

Thanks to a 2014 law, the worst fears of women's health advocates are coming true.

A year ago, when Tennessee passed a bill allowing women to be charged with assault if they use narcotics while pregnant, health advocates warned that the law would deter women from seeking vital medical care out of fear of being prosecuted. Their concerns are now coming true.

“We are getting lots of anecdotal information about women not seeking critical prenatal care, and avoiding going to the hospital to give birth, because they are scared of being arrested and having their baby taken away,” said Allison Glass, state director of Healthy and Free Tennessee, a nonprofit women's advocacy group. “Not only does the current law do nothing to help those who may, in fact, need treatment, but it’s actually having a negative public health impact.”

The controversial law, which went into effect in July 2014 despite vocal opposition from leading medical groups, was passed in response to Tennessee’s growing opioid epidemic. Over the past 10 years, the state has seen a nearly tenfold rise in the incidence of babies born with "neonatal abstinence syndrome" (NAS), a group of symptoms that can occur when babies are in withdrawal from exposure to narcotics.

Babies with NAS may be irritable, have trouble feeding and sleeping or suffer from vomiting and diarrhea, but medical professionals stress that the condition is treatable and hasn’t been associated with any long-term negative consequences.

Critics of the Tennessee law contend that incarcerating mothers and separating them from their babies leads to far more severe health outcomes than NAS, and that it flies in the face of medical consensus.

On Friday, national and international experts on NAS, public health researchers, clinicians, reproductive health advocates and drug treatment professionals are descending on Tennessee to try and convince the state of just that.

A two-day national symposium on pregnancy and neonatal abstinence syndrome is being held in Nashville. The location of the event is no coincidence: As the only state in the country thus far to explicitly criminalize drug use during pregnancy, Tennessee has become ground zero in the debate over how to treat pregnant women who struggle with addiction.

“It creates a separate and unequal system of law for anyone who becomes pregnant.”

Tennessee's law is due to expire under a sunset provision in 2016, unless lawmakers act to extend it. Other states, including Alabama and South Carolina, have used interpretations of existing laws to punish pregnant women who use drugs.

Lynn Paltrow, executive director of National Advocates for Pregnant Women, a nonprofit civil rights group, hopes that bringing experts to Tennessee’s doorstep will encourage legislators to engage with the overwhelming medical evidence showing that punitive measures run counterproductive to the welfare of moms and their babies.

"We either respond to this as a public health issue... or we decide as a society that, yes indeed, we want to put police officers and prosecutors in the delivery room," she said.

Paltrow believes Tennessee’s law sets a dangerous precedent, as it punishes women for risking harm to a fertilized egg, embryo or fetus. “It creates a separate and unequal system of law for anyone who becomes pregnant,” she said.

Since the Tennessee law was enacted, at least 30 women have been arrested for drug use during pregnancy, Glass said, although she suspects the number could be much higher.

A baby receives a dose of morphine at East Tennessee Children's Hospital in Knoxville, Tennessee.
A baby receives a dose of morphine at East Tennessee Children's Hospital in Knoxville, Tennessee.
Wade Payne/AP Photo

She said one of the fundamental issues with the law is that there are simply not enough treatment programs to meet the need in the state.

While women can theoretically avoid serving time by completing a state treatment program, many women face financial and logistical barriers to accessing addiction services. “Some women have to drive hundreds of miles to access a treatment facility,” Glass said. “For low-income women without support systems in place, that option is pretty inaccessible.”

Only two of the state’s 177 licensed residential treatment facilities provide prenatal care on site and allow older children to stay with their mothers.

Mary Linden Salter, executive director of the Tennessee Association of Alcohol, Drug & Addiction Services, said it's common for there to be waiting lists at every facility in the state.

“We don’t have a lot of treatment capacity, and yet we are penalizing women for not being able to get access to treatment,” she said.

In fact, since the law was enacted, Salter said, fewer pregnant women are actually seeking treatment from state-funded treatment facilities. “I think word of mouth, stories about some of the arrests started to make headlines," she said. "There was definitely a drop-off after that point.”

Dr. Jessica Young, an obstetrician at Vanderbilt University Medical Center in Nashville who has a clinic for opiate-dependent pregnant women, said she’s had patients tell her they are now planning on delivering out of state. Others simply drop off the radar.

“We often don’t know why, but we would not be surprised if the law was part of that reason,” she said.

One of the best way to treat babies with NAS, said Young, is to keep them with their mothers.

What these babies need is a quiet, dark environment, and they need to be held and rocked and soothed,” she said, adding that babies who breastfeed are likely to improve faster. “Moms, really in general, are the best at soothing their babies.”

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