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RACINE - When Rachael Lowe sought help for the OxyContin addition she developed while pregnant, she found herself caught by a law not even a decade old.

The "cocaine mom" law started with cases here in southeastern Wisconsin, cases in which mothers were alleged to have been neglectful or downright

malicious.

Regardless of intention, laws often have unintended effects, and that's the question here.

Either the law did precisely what it should, or it's punishing a woman who sought help voluntarily, and it has a chilling effect that discourages other women from seeking help for similar problems.

Unreality TV

"Well, I think the chilling effect is very apparent," said Dr. Brian J. Bear, 46, an obstetrician /gynecologist with Milwaukee Ob /gyn. Few women come to him and talk about addiction problems, he said.

On television shows, addicts are always twitching, with their eyes half open, unwashed hair and dirty clothes. In reality, it's very hard for a physician to spot addiction, Bear said. "They definitely, in most cases, will hide it from you because it is an addiction," he said.

There are signs, such as a mother's failure to gain weight, he said. In the case of cocaine exposure, a fetus may not grow rapidly or not be very active because of the effects of the

narcotic.

You may see minor signs of withdrawal in the mother if you catch her on a day when she hasn't had her fix. But if that patient has had access to her drug, she can appear as a highly functional individual, he said: "And they can fool even the best of us into not knowing."

Even if a doctor suspects addiction, Bear said, doctors may not screen for illegal drug use without a patient's knowledge and consent because those results could be incriminating.

Looking for help

Lowe's addiction was found because she asked for help. She obtained the OxyContin in a relative's house, and after she confessed her addiction to him, they decided to go to Waukesha Memorial Hospital, said Lowe's husband, Michael. They lived in western Racine County, and while Burlington Memorial Hospital was closer, both thought their options and care would be better in Waukesha, he told The Journal Times.

Instead, Lowe's case was referred to Racine County officials, who petitioned a court to confine her. Although she has been receiving treatment for her addiction and the fetal heartbeat is monitored daily, his wife has not seen an obstetrician for prenatal care, Lowe said last week.

Doctor's choice

The initial determination that her fetus may have been endangered was made by a emergency room physician, said Sandra Peterson, spokeswoman for ProHealth Care, which operates the hospital.

"It's up to the emergency department physician to determine if they could be a danger to themselves or others," she said. If someone presents a danger, the doctor is required to notify police, she said.

Not true, said Dr. Steven Leuthner, 42, a neonatologist at the Medical College of Wisconsin and an associate professor of pediatrics and bioethics. While child abuse laws require physicians to report to law enforcement, reporting is optional under the cocaine mom law, he said.

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Tobacco is more harmful to a fetus than an opiate like OxyContin, Leuthner said.

"I guess you can tell my bias about the law - that it's a bunch of crap," he said. "Here's a mom who comes in for care, and what do we do? We criminalize her instead of support her as a patient.

"And these aren't women who want to hurt their baby. They have problems before they're pregnant, and nobody in society wants to help them. We do worry that it's going to drive women away."

"We all know of anecdotal cases that it has. How many of them are out there? I don't know."

Even though it's tempting to continue, many women do stop using drugs while they're pregnant, said Tom DeFrancesco, a psychotherapist at Lakeside Family Therapy: "You know, there's an awful lot of shame surrounding using drugs when you're pregnant." Women who can't stop are usually pretty sick, he said.

DeFrancesco said he has seen many women in his years of practice but not very many pregnant women. "Part of that might be because I'm male," he said.

Law wasn't written

in a vacuum

The cocaine mom law wasn't created in a vacuum, said Bonnie Ladwig, who wrote the law while she served in the Assembly. "We had hearings all over the state with this," and legislators talked to obstetricians, pediatricians, and social workers, among others.

An obstetrician is normally the person who would report a danger to a fetus, Ladwig said. The law made allowance for voluntary reporting of drug use by not requiring doctors to act as policemen and report everything, but to use their discretion and act in a way they feel is right, she said.

In Lowe's case, the unborn child is being protected, Ladwig said.

"Why did she start taking these things while she's pregnant? I mean, I have a real problem with that," she said.

The law has been used perhaps five times, no more than 10, since it became law in June 1998, she said.

"So you're using it less than once a year, but you're at least protecting that unborn child," Ladwig said. And who else is going to take care of that baby?

And yes, tobacco is a problem, and it would be good to control it's use, but it's legal, so you can't, she said.

"Is she (Lowe) getting punished? It kind of looks that way for her now," said Mike Phegley, president of the board of directors of Focus on Community, the new name for the Racine County Council on Alcohol and Drug Abuse. He is also an attorney who practices in Racine and an instructor for business students at Carthage College.

There's a good reason for the law, Phegley said, because some mothers don't seek the care that Lowe sought: "She should be commended that she sought help."

And perhaps the law will evolve to take her circumstance into account. Phegley said he tells his students about the history of the Miranda ruling, which requires police to tell people about their rights when they're arrested. After it was first articulated by the U.S. Supreme Court in 1966, that ruling did lead to some injustices when guilty people were freed, Phegley said, but during the last 40 years that point of law has been refined until it protects everyone in society.

Hopefully, this case will lead to a better resolution for someone else, he said, and ideally it won't take 40 years.

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