She felt her baby inside her and decided it was time to get clean

Feeling the weight of her baby in utero made her want change.

Mary was pregnant, in her second trimester, and homeless. She'd been using heroin for around five years.

But that constant pressure from the baby, she said, was a reminder: "I’m carrying another human being, I need to be responsible for this person inside of me.”

In the wake of the opioid epidemic, more and more women like Mary are struggling with addiction during pregnancy.

The rate of opioid use disorder among pregnant women at delivery more than quadrupled during the period between 1999 and 2014, according to the Centers for Disease Control and Prevention.

While pregnancy for women who are using can raise fears of judgment and of losing their children, it can also be an opportunity to seek help.

For Mary, which is a pseudonym, this pregnancy was a chance at a return to the normal life she once had.

Things started to spiral when she split from her partner, the father of her oldest daughter.

She started using alcohol and drugs. She was abused and then kept using to numb the pain.

Mary said she wanted desperately to be a mother to her daughter again, but her former partner had stipulations – before she could get her child back she had to sober up, find a job and get a safe place to live.

“I kept trying to do those things so I could get her back and I kept failing,” Mary said.

Then she got pregnant with her second child. She wasn't prepared. She’d been struggling with addiction for about five years and she was sleeping on couches, bouncing from place to place.

Eventually, she heard about a program at Swedish Medical Center in Ballard that helps pregnant, addicted women get into recovery.

It’s a 26-day inpatient program funded through Medicaid. It provides medical stabilization in the form of replacement medications like methadone or buprenorphine for opioid users, coupled with things like counseling, parenting classes, group therapy, and intensive case management and planning for life after the program.

In state fiscal year 2018, 560 women were served in programs like this one across Washington.

Staff at the Ballard site estimate at least a third of the women they see are homeless.

They treat a small, but growing, number of women who use stimulants like methamphetamine, and a smattering of alcohol users. Most of the women they treat are opioid users, according to staff.

Lynee Brown, clinical supervisor of counseling at Swedish addiction recovery services, said stigma is a barrier for a lot of women.

Like Mary.

She heard about a friend of a friend who had gone through the program and was doing well, so she was tempted.

But: “I was thinking they’re going to judge me for using, for doing drugs while I was pregnant. They’re going to think I’m an awful mother,” Mary said.

She feared that Child Protective Services would take her baby. And worried she’d already damaged her child.

“I thought what if she’s not okay, what did I do? Did I damage her? Is she going to have problems? That’s going to be all my fault,” Mary said.

There’s still a lot to learn about the long term impacts of opioid exposure in the womb. While babies exposed in the womb can experience neonatal abstinence syndrome, many children grow up to be healthy.

“They [opioids] don’t cause birth defects, which is quite a relief for patients and families to learn that. They can have healthy babies, smart, intelligent kids like anybody else,” said Dr. Jim Walsh, a physician with the Swedish addiction recovery program.

“Most of the risks related to opiate use disorder in pregnancy comes from the withdrawal,” Walsh said.

Research indicates opioid exposure in the womb is associated with cognitive and motor development issues up to age six.

But it's impossible to tell if those results are due to exposure to the drug, or other environmental factors that can go along with parental opioid use.

Eventually, Mary made the call and weeks later prepared to leave her old life.

She spent the 24 hours before entering the program getting rid of drugs and drug paraphernalia, and deleting numbers from her phone.

This wasn’t her first time around in treatment. She’d tried before. But this time was different. Her pregnancy gave her a sense of urgency, and she wanted to get back to her older daughter as well.

“I hoped that when I was going into that program that that would be it, that I would go in there and I would not return back to it, and I have not,” said Mary.

Mary said she was treated with respect and compassion, and she learned a lot from both the staff and the other women going through treatment.

She graduated at the beginning of her third trimester with a plan, follow-up care, and a place to stay.

Mary said those last three months of her pregnancy were totally different.

“I wasn’t waking up to look for drugs, I wasn’t getting high. I was more focused on, okay, I have my planner, where do I have to go today?”

She had outpatient treatment three days a week, she was meeting with her counselor, she was still taking her medication.

And the pressure of her baby in her body felt different, too.

“It was more of a calm, happy feeling,” Mary said. “I was excited about the future, whereas before I wasn’t, I didn’t see a future.”

When Mary finally gave birth, she breathed a sigh of relief. Her baby was a normal weight at 6 pounds, 13 ounces.

She latched well during breastfeeding and they spent time snuggling skin-to-skin.

The baby was monitored for withdrawal for a few days and then Mary got to take her home.

Dr. Walsh with the addiction recovery program said that’s exactly what they want to see.

“Our measure of success from where we sit is are they able to parent their child when they have their child," he said. "That’s going to be evaluated very carefully by the authorities."

The Ballard program was not able to provide data on how many of the mothers they treat go on to parent their children, but Walsh estimates it’s high – around 80 percent.

This kind of intervention, which aims to reduce harm and keep families together, is what the state wants to see, according to Ross Hunter with the state Department of Children Youth and Families.

Hunter said the child's safety is their number one priority, and they will remove children in danger of harm or neglect.

More than 660 infants across Washington were removed from their parents by the state because of parental drug use last year.

Hunter said splitting up families also causes trauma.

"If we can get ahead of that and have an impact on the family at the very beginning and never have a child enter the foster care system, we can increase the likelihood that that kid eventually graduates from high school enormously," Hunter said.

Walsh, with the Ballard program, said not all mothers will maintain sobriety indefinitely. He said people like to think of addiction like a bad case of pneumonia — something that can be fixed after a stay in the hospital.

But Walsh said it needs to be viewed like any other long term illness, like type two diabetes, which needs to be managed over a lifetime .

"If we thought of treating diabetes as a failure anytime someone had a glucose of 200, everybody would be a failure."

Mary has been sober since she left treatment. But it hasn't always been easy. She's needed to reach out for support a few times.

Today, she has a happy 18-month-old baby. She’s reunited with her older daughter. She’s been back to school. She continues to take her medication.

And she hopes her success can inspire other women who may be in the same situation she was in to seek help.