In Indiana, a new law is designed to determine the depth of this problem. But some fear that law intended to help women will one day send them to jail.
Lots of babbling and blowing bubbles puts Aiden Zane right in line with most five-month-olds. But his start in life, a stark contrast from today.
"When we first delivered," said Liz Stewart, "we didn't see any signs. And then on the third day, he started to show signs of distress. He was crying a lot, inconsolable. So they wound up admitting him on the third day."
Admitted, so doctors could use morphine to ween him off methadone, a drug Aiden's mom was prescribed in pregnancy and currently takes.
"It saved my life and saved my son's life," said Stewart.
12 years ago when Liz Stewart was 17, she started having a series of painful surgeries to realign her jaw.
"It was one of those things every time I walked into the doctor," said Stewart, "I walked out with a bottle of pills."
By the time she was 22, Liz knew she was addicted. Addicted to numbing the pain to keep up her active lifestyle. Dance 50 hour work weeks. Addicted to proving she's still that rock.
"I didn't realize how much they were taking over my life," said Stewart, "and I didn't realize how much other people could tell. I really thought I had it under. It was my secret and nobody could tell, but it effected my job, effected my life."
Doctors eventually caught on and cut her off. Withdrawals she says made her physically ill. Too busy to stop, Liz bought her pills on the streets. It went on five years. She tried rehab, quitting cold turkey. But in the end, Liz was still swallowing about 15 pills a day.
And then this...
"The first thing that went through my mind was that I was going to abort it," said Stewart. "It would be my little secret."
A secret since she feared painkillers already caused too much damage. She was 10 weeks along.
"I was still convinced I was going to give him up," said Stewart, "that right before the ultrasound I bought a Rockstar, and I drank half the Rockstar at the time of the ultrasound. So when I saw the ultrasound, he was moving crazy on there, jump jumping wild. So seeing that right there, something I put in my body instantly affected this new being, right then and there it was a shock into realty that I can't continue to do this."
Liz credits caring doctors for getting her on a methadone maintenance treatment plan. A plan backed by the U.S. Department of Health and Human Services. The agency says methadone blocks the effects of opioids and symptoms of withdrawal, which can be fatal to a baby in the womb and doesn't cause birth defects. But it could put the baby through withdrawal called neonatal abstinence syndrome (NAS).
"It's difficult," said Dr. Maria Del Rio Hoover. "They're very irritable. They're very sick. And some babies can have seizures, and the concept of weening them off can be very long term. So, some babies spend weeks sometimes months in the hospital."
Dr. Maria Del Rio Hoover says she's seeing more and more babies born with NAS at St. Mary's Hospital, where she's a neonatalogist.
"All physicians throughout the state are seeing an increase and the experts on pain management are seeing an increase," said Dr. Del Rio Hoover, "but nobody could pinpoint how much, how many babies because the way we clarify and diagnose is inconsistent. Everybody has a different definition there is no consistency in our documentation in sending the records the state."
The Indiana Legislature recently passed a law intended to create consistency. A task force is now working to officially define neonatal abstinence syndrome and determine the best way to track it. That way doctors can identify a baby's long-term health risks and how to help the mothers. Dr. Del Rio Hoover says educating women now could prevent complications during their next pregnancy.
"It's important to be sensitive," said Dr. Del Rio Hoover, "and not make these women feel guilty that this is not a punitive issue. This is a medical issue, and we don't have a lot of services to offer them."
It's considered a medical issue now. But in Tennessee, it's a crime. Tennessee just became the first state in the nation to allow prosecutors to charge women with fetal assault. That law passed in response to data showing a spike in babies born with NAS.
"That's a law that makes it a crime to carry a pregnancy to term if you're a woman who struggles with addiction," said Kylee Sunderlin of National Advocates for Pregnant Woman. "So, what you can see is that what started as tracking and reporting ostensibly for the purpose of public health, quickly can start to look like a pretext for publishing women. And that's very scary."
Women enrolled in a drug treatment program are exempt from criminal prosecution in Tennessee. But programs aren't always accessible. For example, Liz Stewart lives in Marion, Illinois and drives two hours each week to the Evansville Treatment Center. Liz says she's dedicated to getting clean. Even still, she claims to have been treated like a criminal.
"It was the second week in," said Stewart, "a lady walked into my hospital room and said you're really lucky because normally when you see my face, I'm here to take your baby."
Aiden was born in Carbondale. And one of his first visitors, a case worker from Child Protective Services. A visit often required when a baby tests positive for methadone.
"If somebody would have told me that was going to happen," said Stewart, "then I guess I would have been expecting it. But because I was seeking help and told the hospital, I told everybody what was happening. I didn't just show up and let my baby come out and tell everyone it was a surprise. I tried to prepare everybody and show them I was doing the right thing."
Liz says her doctors and nurses vouched for her, so no neglect charges were filed. But it scared her. She shares her story to raise awareness and hopes Indiana tracking birth outcomes will only help women trying to improve their lives.
An Indiana task force is expected to reveal its findings in November. From there, a pilot program will be launched at one or two Indiana hospitals. State Representative Gail Riecken from Evansville co-sponsored the legislation.