When a baby is born, the world usually expects a celebration. But in hospitals across the country, a much quieter, more painful reality plays out every single day. We’re talking about Neonatal Abstinence Syndrome (NAS). It’s what happens when a newborn goes through withdrawal from drugs they were exposed to in the womb. But there’s a specific, often ignored layer to this: NAS introduced by coercion. This isn’t just about addiction. It’s about power, control, and the terrifying ways people are forced into substance use, leading to a medical crisis for a child who never had a choice.
It’s heavy. Honestly, it’s heartbreaking.
Most people think of NAS as a byproduct of a mother’s "choice" to use drugs. That’s a massive oversimplification that ignores the reality of domestic violence and human trafficking. In many cases, the substance use wasn't a party habit or even a personal struggle with mental health—it was a tool used by an abuser. If you aren't looking at the coercion behind the drug use, you're missing half the story.
The Brutal Connection Between Abuse and NAS
Coercion is a dirty word in the medical field because it complicates everything. When we talk about NAS introduced by coercion, we are specifically looking at instances where a pregnant individual is forced, threatened, or manipulated into using substances by a partner or a trafficker. This isn't just "influence." This is "if you don't take this, I will hurt you."
Studies from organizations like the National Center on Substance Abuse and Child Welfare (NCSACW) have shown a staggering overlap between intimate partner violence (IPV) and substance use disorders. Abusers often use drugs as a "chemical leash." It’s a way to keep someone dependent, docile, or simply too impaired to leave. When that person is pregnant, the baby becomes an accidental casualty of that control tactic.
You’ve probably heard the term "reproductive coercion." It’s when an abuser controls a person’s reproductive choices—poking holes in condoms, hiding birth control, or forcing a pregnancy. Combine that with forced drug use, and you have a recipe for a high-risk birth where the infant begins life in a state of neurological distress.
How Coercion Changes the Medical Response
If a doctor sees a baby with NAS, they usually follow a standard protocol. They use the Finnegan Scoring System or the newer "Eat, Sleep, Console" (ESC) model to track symptoms like high-pitched crying, tremors, and poor feeding. But the medical system is often blind to the "why."
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If the mother is a victim of NAS introduced by coercion, her needs are drastically different from a parent who is seeking voluntary recovery.
- Safety is the first priority. If the person who coerced the drug use is in the delivery room, the mother can’t be honest. She’s terrified.
- Traditional "tough love" approaches in social work fail here. If you threaten to take the baby away without addressing the abuser who forced the drugs, you’re just further isolating a victim.
- The stigma is double-sided. She’s judged for the NAS and trapped by the abuser.
I’ve seen cases where the medical staff assumes the mother is "uncooperative" or "shifty" when, in reality, she’s scanning the room for her captor. It’s a systemic failure. We treat the infant's withdrawal symptoms—which is necessary—but we often send the mother back into the same coercive environment that caused the problem in the first place.
The Physical Toll on the Newborn
Let’s be real: a baby going through withdrawal is one of the hardest things to watch. Their nervous system is on fire.
Because of the NAS introduced by coercion factor, these babies often have "poly-substance exposure." Abusers aren't exactly checking dosages or purity. They might force a mix of opioids, benzos, and alcohol. This makes the withdrawal period (the "washout") much more unpredictable. One day the baby is fine; the next, they are having seizures or skin excoriation because they are rubbing their limbs raw against the hospital sheets from sheer agitation.
The American Academy of Pediatrics (AAP) has been pushing for more "rooming-in" policies. This is where the mother stays with the baby to provide skin-to-skin contact, which naturally lowers the baby's cortisol levels. But here’s the kicker: if the mother was coerced, she might be suffering from severe PTSD triggered by the baby’s cries, or she might be in withdrawal herself because she finally escaped her abuser.
The complexity is staggering. It’s not a 1+1=2 situation.
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Breaking the Cycle of Silent Suffering
We have to stop looking at NAS as a standalone moral failing. When coercion is the root, the solution isn't just methadone or buprenorphine—it's physical sanctuary.
Legal systems are slowly catching up. Some states are trying to move away from criminalizing pregnant women, recognizing that the threat of jail actually makes things worse. If a woman knows she'll be arrested because her baby has NAS introduced by coercion, she will avoid prenatal care entirely. She’ll give birth in a motel or a basement. That’s a death sentence for a baby who needs medical intervention to breathe and eat.
In many high-level trauma centers, they’re now using "trauma-informed care." This basically means the nurses don't lead with "What did you take?" They lead with "Are you safe?" It sounds simple. It’s actually revolutionary.
Why the Terminology Matters
Language matters because it dictates funding and focus. If we label these cases as "maternal drug abuse," the focus is on punishment. If we label them as NAS introduced by coercion, the focus shifts to victim advocacy and specialized intervention.
Think about the long-term effects. A child born with NAS may face developmental delays, though many catch up with early intervention. But a child raised in a home where coercion and violence are the norm faces a much bleaker future. Addressing the coercion at the moment of birth is the only way to break the generational cycle of trauma.
What Real Support Looks Like
It isn't just about the NICU. Real support for NAS introduced by coercion involves a multi-disciplinary "war room" approach.
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- Legal Advocacy: Getting restraining orders or helping the mother navigate the legal system without her abuser present.
- Medical Stabilizing: Using low-stimulation environments (dark rooms, soft music) for the infant while the mother receives her own psychiatric and addiction support.
- Long-term Surveillance: Not the "I'm watching you to catch you" kind, but the "How can we help you stay safe this month?" kind.
Honestly, the current system is stretched thin. Most social workers have too many cases, and most nurses are overworked. But the cases involving coercion are the ones that slip through the cracks most easily because the victims are trained to be invisible.
Moving Forward: Actionable Insights for Families and Providers
If you are a healthcare provider or a concerned family member, you can't just ignore the signs of control. You've got to look closer.
For Healthcare Workers:
Look for the "spokesperson." If a partner answers every question for the pregnant person, or refuses to leave the room even for a standard exam, that is a massive red flag for coercion. Use "universal education" about domestic violence so the patient doesn't feel singled out. Provide them with resources in a way that can't be found—like a phone number on a tiny slip of paper hidden in a feminine hygiene product.
For Families:
Understand that the mother is likely a victim, not a villain. If you suspect NAS introduced by coercion, your job is to be a non-judgmental landing pad. If she feels judged, she will go back to the abuser because that’s the only place she feels she "belongs."
For Policy Makers:
Expand the definition of "medical necessity" to include safe housing for mothers of NAS infants. You cannot successfully treat a baby and then send them back into a house where the mother is being coerced into drug use. The "unit" is the mother and child together.
The reality of NAS introduced by coercion is uncomfortable. It forces us to look at the intersection of crime, health, and gender-based violence. But ignoring it doesn't make it go away; it just ensures that the next generation starts life with the deck even more stacked against them. We have to do better at identifying the invisible strings of control before the baby is even born.
Practical Next Steps
- Screen for IPV Early: Every prenatal visit should include a private, one-on-one screening for intimate partner violence and coercion.
- Prioritize ESC Models: Encourage "Eat, Sleep, Console" protocols that keep the mother and baby together in a secure, monitored environment.
- Lobby for Safe Harbor Laws: Support legislation that protects pregnant victims of coercion from criminal prosecution if they seek help for substance use.
- Educate the NICU: Ensure neonatal staff are trained to recognize the behavioral signs of a parent living under coercive control, rather than dismissing them as "difficult" or "uninterested."