Newborns cry, but not like this.
Thirteen months ago, Courtney Castonguay held her daughter Emma in her arms as the baby cried incessantly.
A “high pitched” cry, Castonguay said, different from the other babies around her at a Hamilton hospital.
Castonguay tried everything in her power to comfort her little girl, but she knew only one thing could.
“I felt like the worst mother in the world,” Castonguay said in an interview. “She was suffering because of my choice.”
Castonguay, 21 at the time, suffered too — tormented with guilt and fear.
She was addicted to opioids at the time, having used them regularly since high school.
During her pregnancy, she was taking hydromorphone and fentanyl, but was too afraid and ashamed to tell her doctor.
“I hid it the whole time. The entire nine months,” Castonguay said. “I was scared she was going to get taken away from me.”
But once she saw how sick Emma was she told doctors, who quickly confirmed the little girl was born with an addiction.
Treatment soon began with what the baby needed even more than her mother: morphine.
Hundreds of NAS babies
Emma is one of hundreds of Canadian infants hospitalized last year with neonatal abstinence syndrome (NAS).
They are the small, innocent victims of an opioid crisis policy makers and health-care officials are struggling to contain.
Between April, 2016 and March 31, 2017, the Canadian Institute for Health Information (CIHI) identified 1,846 babies admitted to hospital after being exposed to opioids during pregnancy.
The tally does not include the province of Quebec, which keeps its own statistics.
More than half of the cases — 988 — were in Ontario, where CIHI has tracked a steady increase in NAS since 2012.
The numbers back up what health care providers have been witnessing firsthand.
Taking at toll on health care
At St. Joseph’s Healthcare in Hamilton, social worker Sarah Simpson says their neonatal unit, where she’s worked for 20 years, used to treat approximately one baby for NAS every six months.
Now the unit is treating between two and five babies for NAS at all times.
“It’s really difficult for the staff,” Simpson said in an interview.
Babies with NAS sometimes need to be held for 90 per cent of the time they’re in hospital, Simpson said, which can last as long as eight weeks.
Hospital staff continue to monitor babies with NAS, and their parents, for 18 months after birth.
It’s a time when parents also need support.
“There’s a lot of shame. There’s a lot of guilt,” Simpson said. “We’re not here to to judge.”
The rising numbers are stretching hospital resources thin and Simpson would like to see the establishment of a centre similar to Fir Square Combined Care Unit at Vancouver’s B.C. Women’s Hospital.
The centre is the first in Canada to care for women who use substances and their newborns exposed to substances in a single unit.
Dr. Maya Nader, who specializes in addictions at St. Michael’s Hospital in Toronto, says the increase in NAS is a burden on the health-care system, requiring more hospital beds, pediatricians and nurses.
“I’m worried because, in general, there is too much opioid use in the population,” Nader said in an interview.
She attributes the higher rate of NAS in Ontario to its larger population and higher rates of opioid use.
Looking for solutions
Ontario Health Minister Eric Hoskins says the government is addressing the opioid crisis but that “there’s always more work to be done.”
In an interview, he said ministry staff will be investigating why far more babies are born with NAS in Ontario than other provinces.
“We’ve got tremendous expertise on this issue. I’m confident we can not only have a clearer determination of what the reasons might be, but what specific support and interventions would prove helpful,” Hoskins said.
Support is what got Courtney Castonguay and Emma through.
Now 13 months old, Emma is happy and healthy. After early struggles, she’s now has a healthy weight and her recovery is ahead of schedule.
“She’s come so far, I can’t even believe it,” Castonguay said.
But it wasn’t easy.
“You’ve got to have the right support. Some people can’t handle it. It’s just too hard to watch a baby go through that. Especially your own baby.”
Castonguay is grateful to have received the support she needed and hopes others will get it, as the opioid crisis worsens and more babies are born with NAS.
“I got lucky and she’s an amazing little girl.”