"I was terrified to keep using, but terrified to stop too," Sarah said.
Terrified because at 24 she was pregnant and hooked on heroin. "Sarah" asked we protect her identity.
"People judge moms that are in recovery and say that they don't love their children. They would stop using if they loved their children. And that has nothing to do with it," she said.
Sarah didn't know she could conceive. Heroin had stopped her menstrual cycle. She was in her second trimester when doctors told her she was pregnant.
"I was completely shocked," she said. "And I still remember the horrific, guttural scream that came out of my mouth."
She had been in and out of rehab a half dozen times and her fight to stay clean was about to get harder. Pregnancy and the months following are common times for relapses. But quitting cold turkey can also kill the fetus.
"My baby and I were going to be OK as long as I stayed on the methadone and didn't use," Sarah said.
According to the latest figures released by the health department, about 3 percent of Vermont babies are born opiate-dependent. But those stats are 4 years old and health professionals we spoke with say the numbers are higher. In 2012 Fletcher Allen Health Care in Burlington reports about 6 percent of its newborns were exposed to opioids during pregnancy; for Dartmouth-Hitchcock it was about 7 percent and Rutland Regional Medical Center says 8 percent of their newborns were diagnosed with neonatal abstinence syndrome.
And of the pregnant women in Vermont trying to kick their habits, 80 percent were on opiate replacement therapy-- like methadone or buprenorphine-- when they gave birth, elevating the risk that their newborns will crave the medication, too.
"It's not a tragedy, I like to say, because it's easily treated," said Dr. Anne Johnston who runs the Neonatal Medical Follow-up Clinic at Fletcher Allen.
Johnston says when babies are exposed to opiates in the womb, 20 percent will require treatment for neonatal abstinence syndrome. The symptoms include: irritability, high-pitched cries, sleeplessness, an inability to feed, rapid breathing, low birth weights, excessive sneezing or yawning and tremors. Traditionally these infants are kept in the hospital and treated with a narcotic pain reliever called morphine until their symptoms subside. But Fletcher Allen is bucking medical norms by giving the babies the same opiate replacement medicine as their moms.
"Many people are shocked that we give methadone to little babies," Johnston said. "But we're not giving it to them to have them drugged. We're giving it to them so they can grow and develop normally."
The hospital is just one of a few in the country that has used this technique for more than a decade. The methadone solution is applied inside the infant's cheek. Sarah's son needed less than 1 milligram a day for about six months.
"I think we were amazed, at first, that people trusted us to take home this medicine. But we knew it was for our son, and it was never anything that we would even consider taking for ourselves," Sarah said.
"We're lucky in Vermont that we can do this and we can actually setup a model for other states to do this," Johnston said.
She says with methadone babies are out of the hospital within six days, rather than 16-20 when treated with morphine, allowing for better bonding and breast-feeding. On average, infants were weaned off the medication within three months.
"We started doing this because we felt that the babies would be better at home taken care of by their parents," Johnston said.
But it's model that won't work just anywhere, especially urban hospitals where patient caseloads are much higher. Johnston says sending parents home with methadone requires close supervision and frequent follow-ups. Not every facility has the staff to support it.
And there are some within the medical community who simply don't believe in these addicted parents.
"There was a nurse in there who let me know in no uncertain terms that I did not deserve this baby and it was wrong that I was allowed to take him home," Sarah said.
Ten years sober, Sarah now works to change those attitudes by visiting hospitals and raising awareness about how staff can improve care for opiate-exposed newborns.
"I have an amazing life now. I have self-respect. I have dignity. I can look in the mirror," she said. "My children don't know me as a using addict and they never will. They know me as a mom in recovery."
Sarah went back to college, graduated with honors and had her second child. She now works with a program called ICON, or improving care for opiate-exposed newborns. It's a joint venture between UVM, the Vt. Health Department and Fletcher Allen. The data collected is used to identify gaps in care and resources.