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鈥淟ook at that little bald head,鈥� Jewel Adams said.

Moving toward Adams in the arms of her mother, and wearing a ruffled, magenta onesie, is 3-week-old Safiyah James.

鈥淗i Sophia,鈥� Adams said.

鈥淚t鈥檚 Sah-fiyah,鈥� said Kia Nassik, 27, as she allows Adams to hold her daughter in her apartment just south of Madison, Wisconsin. Safiyah sticks out her lower lip, squints her eyes and lets out a small cry.

鈥淪he saying, 鈥榯hese ain鈥檛 my mama鈥檚 hands.鈥� I know, I know,鈥� Adams said, rocking Safiyah for a few moments before handing her back to her mother.

Though this is Nassik鈥檚 second child鈥攕he has a 5-year-old daughter as well鈥攕he feels like a first-time mom. During her first pregnancy, she tells Adams, Nassik was in the midst of a seven-year addiction to crack cocaine and heroin. This time, she鈥檚 celebrating two recovery milestones: one year since using crack, and two years since using heroin.

鈥淚 look everything up online,鈥� she told Adams. 鈥淲hen I first got home, [I Googled] how to hold a newborn the correct way.鈥�

Adams is a coach for Pregnancy2Recovery, a program that connects pregnant women struggling with with recovery coaches. Having fought through their own experiences of addiction during pregnancy, the coaches give hope and resources to other pregnant people. Nassik, a coachee, was one of them. 

Even though she is not now working with Pregnancy2Recovery, the program made a difference during Nassik鈥檚 pregnancy. 鈥淚 struggled quite a bit during my pregnancy,鈥� Nassik revealed in a hushed voice. 鈥淔or some reason I was craving crack,鈥� Nassik said. 鈥淚t鈥檚 not even my drug of choice, but I鈥檝e never been addicted to something that鈥檚 so mental.” 

Like Nassik, people all over the country are making tough decisions about themselves and their children in an often hostile system where honesty can bring shame and fear: When mothers are afraid to be honest with their doctors, they may hide that they鈥檙e struggling with addiction or skip doctor鈥檚 visits altogether. This is particularly a crisis in Wisconsin: It鈥檚 the Midwestern state with the experiencing drug withdrawal, and the state鈥檚 鈥溾�� puts women at risk of prosecution, forced medical care, and losing custody of their children.

In Jan. 2020, passed in the Wisconsin House of Representatives that makes it easier for the state to terminate a substance user鈥檚 parental rights. Under the new statute, if a baby is found to have drugs in their system at birth, parental rights can be immediately terminated unless the mother enrolls in a treatment program within 90 days. 

鈥淸These women] don鈥檛 trust the system,鈥� said Dr. Kathy Hartke, an obstetrician-gynecologist who has been practicing in Wisconsin for more than 30 years. 鈥淭hey hear about [the Cocaine Mom Law] from other sources, from friends, and they don鈥檛 come for prenatal care because they think their babies will be taken away if they come during their pregnancy.鈥�

show that the fear of being reported to Child Protective Services deters women who use alcohol and/or drugs from seeking out or following through with prenatal care. It鈥檚 a problem that only becomes worse when legislation defines using drugs or alcohol during pregnancy as child abuse/neglect.

Better outcomes

鈥淲hen I found out I was pregnant, I wasn鈥檛 ready by any means,鈥� said Tanya Kraege, one of Pregnancy2Recovery鈥檚 developers. 鈥淚t was an unplanned pregnancy, and I was using drugs.鈥�

Still, Kraege wanted to do right by her child. For eight months, she abstained from drugs and alcohol. Then, Kraege鈥檚 doctor said she could have a glass of wine. It helps with the stress of the third trimester, he told her. 

Kraege relapsed that night and used cocaine for two days. 鈥淚 thought that my child was going to be enough for me to not use, and that wasn鈥檛 the case,鈥� she said.

Fearing the impact on her baby, she told her doctor. 鈥淚 felt really ashamed,鈥� Kraege recalled. 鈥淗e was so good to me. He didn鈥檛 make me feel guilty or judged. He took the time to help me.鈥� 

Kraege鈥檚 doctor recommended she go to intensive outpatient treatment. Following his direction, she remained sober for the rest of her pregnancy. But many women don鈥檛 have that experience. Faced with the possibility of prison time or losing their child if they鈥檙e honest with their doctors, many stay silent.

In Wisconsin, the number of or another addictive substance during pregnancy tripled from just over 300 in 2009 to over 1,000 in 2014, according to the Wisconsin Department of Public Health. Studies have shown that pregnant women with substance use disorder are some of the most vulnerable in our society, often having , child abuse, domestic violence, mental health disorders, and houselessness. 

Those addicted to substances often feel judged by their medical providers, Kraege explained, and often lack the resources to get help.

This need lead Kraege and her co-developer Skye Boughman to create a program based on personal relationships with someone who understands the guilt, shame, and stigma of having a child while in the grips of addiction. In addition to being trained as advocates, the recovery coaches鈥攚ho are required to be sober for at least one year鈥攁re in long-term recovery themselves. 

Since Pregnancy2Recovery鈥檚 inception in 2017, 36 women have been referred to the program, 31 have met with coaches and 14 are either graduated or currently enrolled. The program is open to all pregnant people, regardless of gender identity, and has been expanded to work with fathers and facilitate anti-stigma training for medical professionals. 

While the field is new, early research shows that recovery coach programs for pregnant women lead to better outcomes for both mother and child, because they take a trauma-informed, holistic approach. 

This distinction often makes all the difference in whether a woman stays in addiction treatment. One study showed that women in pregnancy-specific treatment programs were than those in traditional programs, particularly if the program addresses other trouble areas, such as prenatal care, finding a job or home, therapy, and nutrition. 

Recovery coach programs are particularly promising because the intersecting gives the coach credibility and compassion, while also allowing them to provide valuable insight. Studies show that a family-focused approach leads to for both the mother and her child, significantly reducing the risk of substance abuse exposure at birth.

Coaching looks different for everyone. For Adams, who鈥檚 been a coach since the beginning of the program, it means getting up early before work to take the bus each day one hour downtown to visit coachees in drug court or the county jail. She also works another job and is a mom and grandmother.  

Other coaches attend doctor appointments with their clients, get them into treatment programs or help them apply for resources such as food assistance. Most importantly, the coaches act as advocates, helping their coachees learn to navigate doctors鈥� offices, drug court, looking for housing, and learning to be a parent鈥攖hings that can be challenging for any person in recovery, but all the more overwhelming when pregnant. 

Still, while there鈥檚 great interest in expanding the program in other locations and states, the thing that makes it so effective鈥攖he personal and nuanced nature of the care鈥攎akes it hard to replicate. 

鈥淧eople using substances, they don鈥檛 trust people,鈥� said Kraege, adding that it can take more than six weeks for a coach to build rapport with their coachee. 鈥淸Adams] does so much more than coaching 鈥� handing out brochures and meeting people on the bus and just really wanting to help. She鈥檚 really able to have [empathy] on a deep level because of her own experiences.鈥�

Back at Nassik鈥檚 house, two women, united in a shared story, are celebrating. 鈥淜ia, you can beat [the cravings],鈥� Adams said. 鈥淚 just made 15 years [sober]. I鈥檓 not saying that it鈥檚 going to stop because it鈥檒l never stop. It鈥檒l never stop it, but it鈥檒l get better.鈥�

鈥淭hat鈥檚 a big deal,鈥� Kia said as the two embrace. 鈥淚 can鈥檛 wait to be able to say that.鈥�

This story is a that will be screened at the in March, 2020. It has been supported by the , a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems, and by the at Northwestern University鈥檚 Medill School of Journalism, Media, Integrated Marketing Communications.