Neonatal withdrawal syndrome after prenatal drug exposure

Neonatal withdrawal syndrome after prenatal drug exposure, called neonatal abstinence syndrome or NAS in the book, is a withdrawal condition that can follow opioid exposure in the womb. It connects the opioid crisis to the earliest stage of life: infants may need prolonged hospital care, while their mothers face the difficult task of finding treatment amid uneven access to medication and social judgment. The account gives the syndrome clinical detail, but also measures its effects through the contrasting outcomes of newborns and the families trying to care for them.

Exposure and the Newborn Experience

The book describes NAS as a painful withdrawal state that can require lengthy hospital stays. Affected infants may have difficulty settling and feeding, and some need treatment in a neonatal intensive care unit. The account makes clear that exposure does not produce the same outcome in every pregnancy: even infants born to mothers receiving medication-assisted treatment may develop NAS, and the possibility of withdrawal can weigh heavily on expectant parents.

The scale of the problem was visible in Roanoke. In the year described, fifty-five babies were born with NAS at the city’s public hospital, a rate well above the state average. Infants released from neonatal intensive care could return to a regional clinic for weekly check-ins, where they were gradually weaned from methadone under the supervision of their mothers or other family members. That follow-up did not remove the risks surrounding family stability: about 27 percent of the clinic’s babies eventually entered foster care.

Tess Henry’s Pregnancy and Her Son’s Outcome

Tess Henry left jail in June 2015 when she was nearly seven months pregnant. After a month living with her mother, Patricia, and attempting to make a relationship with the baby’s father work, Tess entered the Life Center of Galax, one of the few facilities in Virginia that accepted patients receiving medication-assisted treatment. Private insurance covered most of the $20,000 cost; Tess’s father paid the $6,500 deductible from the remainder of her college savings.

Tess had spent the first half of her pregnancy addicted to heroin and the second half taking Subutex, a buprenorphine medication then recommended for some pregnant patients. Subutex contains buprenorphine without the added naloxone found in Suboxone. At the time, it was considered safer for the baby, though more liable to misuse by the mother. Tess was anxious that her son might be born with NAS, a concern shaped by the possibility of withdrawal and intensive treatment.

Her son arrived two weeks early but was remarkably healthy, with no signs of distress. He was not among the fifty-five NAS births at the public hospital that year, nor among the infants requiring the regional clinic’s continuing care. The contrast between Tess’s fear and her son’s outcome gives the account a specific counterpoint to the broader statistics: prenatal opioid exposure carried serious risks, but did not determine every newborn’s condition.

Treatment Access and Uneven Care

The book situates neonatal outcomes within a wider treatment system in which effective care could be difficult to reach. Buprenorphine helped Tess feel normal, prevented withdrawal, and reduced cravings, but receiving it required substantial out-of-pocket payments. Her insurance covered 80 percent of the medication; addiction-doctor visits were cash-only, requiring $700 up front and $90 to $100 for each follow-up, which could occur as often as four times a month. Patricia objected to the cost and described waiting lists for treatment providers as another barrier.

Federal rules then limited MAT-certified doctors to treating 100 patients at a time; the cap rose to 275 later in 2016. In 2017, access in Virginia began to broaden through the work of Hughes Melton, an addiction specialist who helped lead the state’s opioid response. He worked with Medicaid officials to expand reimbursement and cover required counseling and care coordination, partly to encourage cash-only clinics to accept insurance. The change offered a route toward more accessible care, but the book emphasizes that recognition and availability lagged behind need.

Treatment was also constrained by disagreements over medication. In some Narcotics Anonymous meetings, people taking buprenorphine were regarded as not being clean or as merely substituting one opioid for another. Although the organization’s official policy accepted medication-assisted treatment, longtime members declined to sponsor or mentor Tess. The resulting rejection shows how stigma could persist even where formal policy permitted treatment. For pregnant patients and new mothers, the consequences of such attitudes reached beyond recovery: they could affect whether families and caregivers supported a treatment plan intended to protect both mother and child.

Public Health and Family Support

The account also records a shift in how caregivers understood mothers whose babies were exposed to opioids. Hospital staff had once treated these women harshly, including staff who later acknowledged that they had misunderstood addiction. Their changed perspective was that mothers needed support, both for their own health and for the baby’s care. That recognition challenged a moralizing response that treated pregnancy and drug use as evidence of parental indifference rather than as circumstances requiring medical and family support.

NAS therefore appears not as an isolated diagnosis but as one point in a larger chain of care: prenatal treatment, delivery, possible intensive care, gradual medication withdrawal, and the support available to a family afterward. Tess’s son’s healthy birth, the fifty-five hospital cases, and the clinic’s foster-care figure reveal different parts of that chain. The book uses their contrast to show why outcomes depend not only on exposure, but also on whether treatment and sustained support are available without prohibitive costs or stigma.