DULUTH - When Theresa Wanless learned she was five months pregnant with her second child, she knew something had to change.
"I immediately told my OB, 'I'm addicted to heroin,'" the Duluth woman related. " 'I shoot up. I need help. I can't just stop.' I was honest because I was scared for my child, but I couldn't just stop."
It was early in 2014, and Wanless was caught in a wave of opioid addiction that was hitting Minnesota and the nation and increasingly affecting pregnant women and their babies as well.
From 2012 to 2015, the number of newborns in Minnesota needing special treatment because their moms were addicted to opioids more than tripled, from 239 to 765, according to the Minnesota Department of Health.
As with the opioid crisis in general, the impact on Minnesota infants hasn't hit all groups equally. According to the Minnesota Department of Human Services, the prevalence of babies born with neonatal abstinence syndrome - i.e., on withdrawal from the drugs their mothers used - is more than seven times more likely to affect Native American infants than non-Hispanic whites, said Dr. Rahul Koranne, chief medical officer for the Minnesota Hospital Association.
Neonatal abstinence syndrome occurs when a baby in the womb who has become dependent on a drug in her mother's bloodstream goes through withdrawal after birth, when the drug is no longer available, said Lori Swanson, nurse manager of the birthing center at St. Luke's hospital in Duluth.
It's a hard way to start life.
"Imagine a baby that is screaming, crying, is very irritable, muscles are contracting, the sleep patterns are disorganized ... diarrhea, vomiting, constant drooling," Koranne said. "What everybody wants to be the most joyous minutes of their life (becomes) a horrific nightmare for everyone involved."
For the most part, though, the baby's rough start in itself doesn't foretell health problems down the road.
"It's awful to see," said Tammy Harvanko, a registered nurse who serves as high-risk OB clinical care coordinator at Hennepin County Medical Center in Minneapolis. "But the thing is, it's very treatable, and the newborns can get through that period of withdrawal by medical management if it's necessary. ... It's a very limited time in the span of this child's life."
Agencies, tribal and governmental units and health providers across Minnesota are working to eliminate the hurdles that made it difficult for pregnant women using drugs to get help. For example, Essentia Health in Duluth began a partnership in September with the ClearPath Clinic at the Center for Alcohol and Drug Treatment, which offers methadone and Suboxone as treatment for drug addicts. Led by Dr. Andrea Wahman, an Essentia obstetrician/gynecologist, it's called the Clear Start Clinic and allows pregnant women who are recovering addicts to get prenatal care in the same place where they get their drug maintenance therapy.
Among other efforts across Minnesota:
• The White Earth Reservation's MOMS program, a culturally specific holistic treatment program, provides daily doses of Suboxone for pregnant women who were addicted to opiates.
• Sanford Health, Beltrami County and Red Lake Family Services created First Steps to Healthy Babies in response to the large number of babies born to mothers using drugs. An estimated 95 percent of women participating in the program have been able to take their babies home with them instead of them being placed in the county's care, said Ali Bruning, case manager for the program.
• The Superior Babies program, operated by the St. Louis County Department of Health and Human Services, promotes sobriety for women who are struggling with addiction to drugs and alcohol, said Wendi Tvedt, public health nurse senior.
• The Minnesota Hospital Association, with federal grant money via the state's Human Services Department, is developing a "roadmap" to focus on neonatal abstinence syndrome, Koranne said. A key element is drug screening for all pregnant women as early in the pregnancy as possible.
Wanless gave birth to a healthy baby on May 25, 2014, who never went through withdrawal even though her mother was using methadone to break her addiction to heroin.
Now completely drug-free with three healthy children, Wanless works at a local nursing home and is studying to be a nurse.
It's the kind of success story people involved with the program hope to see occurring more frequently throughout the state.
"I want a healthy baby, a healthy mother and the baby to go home in the mother's arms," Harvanko said. "That's what I want for these women, is to have their lives in a stable place that they can parent."