NEW BEDFORD, Mass. — Eight-day-old Braylin Debonise dozes in her crib, barely a week into the world and blissfully unaware.

She doesn’t realize that she is spending the first few weeks of her life being treated for the opioids she was exposed to at birth.

Amanda Fielding and her daughter Briella Debonise, 20 months, take a closer look at Braylin Debonise, 9 days old, at St. Luke's Hospital in New Bedford, Mass. Both of Fielding's daughters were born with an addiction to methadone. Peter Pereira/Standard-Times

She doesn’t yet understand that her mother’s history of addiction led to her needing special care and treatment in the first days, months and years of her life.

She doesn’t recognize the determination of her mother to live a clean life, with the support of her father, also a recovering addict.

But she will learn all of this in time. Her mother, Amanda Fielding, has no plans to hide the truth from her and her sister, Briella, 20 months old.

Briella was also born addicted to methadone.

“I don’t want to hide anything from them,” she said. “I’m not going to sugarcoat it. I’d rather be honest with them. As they get older, I don’t have a problem talking to them about it.”

A DESTRUCTIVE PATTERN

Fielding was abusing prescription pills by 13.

By 24, she was an IV heroin user.

She “died” four times, revived by doses of Narcan, a drug given to counteract the effects of an overdose.

Her days passed in a destructive, droning pattern. She woke up sick and with one thought racing through her mind: Need more heroin.

To fund her habit, she stole jewelry and “anything and everything” from people, including her parents.

She would mix heroin and benzodiazepine medications, often called “benzos” for short, which are widely prescribed for the treatment of anxiety disorders and insomnia. That, she said, was “a very dangerous thing to do.”

“I fought it for a long time,” she said. “I was sick and tired of being sick and tired.”

On March 1, 2013, Fielding entered a methadone clinic and celebrated her first day of sobriety. “Pretty much I’ve been clean since then,” she said. “The clinic saved my life.”

Treatment, she stressed, involved more than a visit to the clinic in the morning, getting a dose of methadone and leaving.

She participated in group and one-on-one therapy. “It’s a whole different lifestyle,” she said. “You really have to want it.”

And while she was in treatment, fighting for her sobriety, she became pregnant.

At one time, women who gave birth to babies exposed to narcotics were treated with scorn and shame, experts said.

WORKING WITH THE MOTHER

That attitude does little to help either the mother or the baby, according to those who work closely with them.

“This mother has an illness; she has an addiction,” said Dr. Brian Sard, chairman of pediatrics for Southcoast Health. “We work with them as opposed to working against them.”

The earlier a drug-addicted woman reaches out in her pregnancy, the more likely she and the baby are to have a positive outcome, experts said.

Close medical supervision can help ensure the mother does not withdraw from the drug cold turkey or overdose, Sard said.

For heroin users, “every effort is made to get them on methadone” to maintain a stable pregnancy, said Dr. Jessica Slusarski, site leader for the St. Luke’s Hospital Special Care Nursery.

Expectant mothers can then be placed on a “maintenance program” that can range from making every effort to stop smoking marijuana, for example, to ensuring the mother-to-be remains in methadone treatment as she withdraws from heroin.

And the women receive more frequent monitoring to ensure the fetus is growing at a healthy rate. This kind of positive treatment is far more likely to result in a healthy baby and far less likely if a woman feels she would be shamed for her situation, experts said.

Once the baby is born, a medical team works closely with the mother and the infant.

Both are visited by medical staff every three hours to take their vital signs such as blood pressure and temperature. This helps them monitor for signs of withdrawal.

All of this work is done “as inclusive of the parents as possible,” said Dr. Slusarski. “We promote the parents’ comfort and readiness.”

Nurses are trained on how to evaluate these symptoms. An infant may naturally exhibit one or two of these signs, Dr. Slusarski said, but when “when things start adding up” the baby may need medication to help withdrawal.

‘A TEAM EFFORT’

The goal is “not to sedate the baby, it’s to manage the withdrawal,” she said.

In addition to the medical intervention, “a team effort” goes into place, she said, that often includes social workers and lactation specialists.

An occupational therapist also comes in and works with the baby, perhaps offering infant massage and teaching parents to do the same, said Sard.

“We see lots of mothers being more proactive,” said Lisa Tibbetts, registered nurse and director of the family centered unit at St. Luke’s Hospital.

The approach “has moved away from, I’m doing something in secret,” she said.

Heroin might be the drug publicly associated with babies born exposed to opioids, but medical experts locally are seeing a new trend: Mothers addicted to several substances at once. In many cases, they are addicted to pharmaceuticals.

Dealing with babies born to mothers with this addiction, known as polypharmacy, “is more complex,” Dr. Sard said.

Dr. Leslie Kerzner, director of newborn follow-up program and staff neonatologist at Massachusetts General Hospital in Boston, agrees. And she places some of the responsibility for the growing number of cases on the medical establishment’s increased reliance on pain medication.

“Pain became the fifth vital sign,” she said.

To eliminate pain, doctors would prescribe pain medication and some patients would keep extra pills on hand, which could then find their way to others in the household, she said.

Now, she said, “we have all these addicts to deal with.” As a result, she said, “we’re not going to see a decrease soon” in prescription pill abuse and with it, pregnancies in women struggling with these substances.

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