Among the least reported aspects of the opioid epidemic is the impact of prescribed opioids on pregnant women and their babies. See the March of Dimes’ fact sheet here. Doctor-prescribed opioids are commonly used for pain treatment following surgery or an injury. Common opioids include codeine, hydrocodone, fentanyl, oxycodone, and others. Women who are pregnant need to be extra cautious because small amounts of opioids are found in many over-the-counter medications like some cough syrups and drops.
One of the most common conditions suffered by opioid-addicted newborn babies is neonatal abstinence syndrome (NAS). This is when the baby suffers addiction withdrawal symptoms after birth. Like many other substances — for example, alcohol — if the mother is on opioids, so is her baby. This true even if the opioids are prescribed, even if used only in the amounts prescribed and even if used only early in the pregnancy. When the baby is born, he or she is no longer receiving the opioids that were being provided by the mother through the umbilical cord. The result is “cold-turkey” withdrawal. According to descriptions, the result is as horrible for the baby as it is for the new parents. As reported here, a baby afflicted by NAS began wailing six hours after birth and nothing could comfort the child. “‘It got horrific,’ his father remembered. It was the addiction taking hold. Less than a day old, [baby] Kemper was suffering from opioid withdrawal.”
Medically, the solution is to keep the newborn in the hospital and administer ever-diminishing amounts of opioids and anti-addiction drugs. This eventually weans the baby off of the opioids and the baby can go home.
Use of opioids by the mother can cause other serious problems for the baby including:
- Placental abruption — the placenta grows along with the baby providing the baby with food and oxygen through the umbilical cord; abruption occurs when the placenta separates from the uterus wall which can cause miscarriage or premature birth
- Miscarriage or stillborn baby
- Early labor and premature birth — preterm babies are born smaller and are more likely to have health and development problems as they grow
- Birth defects such as misformed or malformed organs and neural (spine and brain) defects like spina bifida — these can occur independently of or in conjunction with premature birth
- Low birthweight and/or fetal growth restriction — use of the opioids causes the baby to not gain the weight he or she should during gestation; this can also result in after-birth growth problems
In addition to birth-related complications, use of opioids during pregnancy is correlated with later childhood development and cognitive issues and, it is speculated, later-in-life propensity to addiction and addictive behaviors. There are ongoing efforts to study the long-term impact on the lives and development of opioid-addicted babies, but the effects are still unknown. Cocaine use during pregnancy has been shown to create long-term developmental and behavioral problems. It is feared a similar correlation will be found for other opioids.
What About Breastfeeding?
Taking opioids while breastfeeding is complicated because the issue depends on whether the baby has NAS and, even then, the medical science is very unsettled. In general, breastfeeding is “good” for both mother and baby since it helps with bonding, postpartum depression and helps the baby build his/her immune system. But, in general, what the mother is eating, drinking and using shows up in the breast milk. Thus, mothers who are breastfeeding should definitely seek and follow medical advice before using opioids. On the other hand, the medical research DOES seem to indicate that, if the baby has NAS, use of opioids by the mother while breastfeeding may help make the withdrawal less severe. Again, seek and follow medical advice on this issue.
Possible Malpractice for Opioid-Addicted Babies
Most opioid-addicted babies become addicted as a result of the mother’s use of illegal opioids like heroin. But for many, the opioid addiction results from prescribed and legal opioids. Medical malpractice may have been committed if a physician prescribes opioids for a pregnant woman and her baby is affected. The mother and her baby have potential causes of action hereunder Georgia law to recover compensatory damages. If this has happened to you or someone you know, contact the proven attorneys at the Roger Ghai Law Offices.
Under Georgia law, to recover for medical malpractice for opioid mis prescription, a victim — like a mother and her baby — must demonstrate, to a reasonable degree of medical probability, that (1) the physician breached the applicable standard of care and (2) that breach of the standard of care proximately caused (3) the injury to the mother and/or her baby.
Whether there has been malpractice depends on many factors. With respect to the applicable standard of care, the American College of Obstetricians and Gynecologists (ACOG), for example, does NOT offer guidance saying that opioids can NEVER be prescribed during pregnancy. The ACOG offers guidance that all considerations be balanced including effectiveness and safety of alternative pain medications, the exact use of the opioid, the timing and length of use, the impact on the baby and the treatability of any resulting NAS experienced by the baby. The ACOG states:
“… it is important for health care providers to understand that use of opioids during pregnancy can be indicated. Opioids should only be used for treatment of pain when alternatives are not appropriate or effective, but we also know that there are times, including during pregnancy and the postpartum period, when such use is both appropriate and safer than the alternative.”
Postpartum use, of course, goes to the issue of breastfeeding. Examples include use of opioids near the birth — which have less impact on the baby — as pain mitigation for the natural birth or a c-section birth.
As can be seen, malpractice cases are complex and fact-intensive.