This story was produced by Wisconsin Watch, a nonprofit, nonpartisan investigative reporting organization that focuses on government integrity and quality of life issues in Wisconsin.
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By Phoebe Petrovic, Wisconsin Watch
Tamara Loertscher arrived at the Mayo Clinic Health System in Eau Claire, Wisconsin on Aug. 1, 2014 despondent. The 29-year-old had suffered depression all her life, but in recent months, her mental health grew especially desperate. She struggled to eat and get out of bed, thinking of harming herself.
Severe hypothyroidism fueled her anguish. Untreated, it causes debilitating depression and fatigue. Loertscher had required daily medication since radiation treatment killed her thyroid. But she was unemployed and uninsured, and, facing a yearlong wait for BadgerCare, unable to afford the drugs.
When one home test, and then another, indicated Loertscher was pregnant, she went to Taylor County Department of Human Services, saying she needed treatment she could not afford for depression and hypothyroidism. Workers directed Loertscher to the hospital’s emergency room where she voluntarily admitted herself to the behavioral health unit.
Under “reason for admission,” the medical records quoted Loertscher: “ ‘I really needed help.’ ”
An ultrasound showed a 14-week-old, healthy looking fetus. When Loertscher heard the news, she cried with relief.
After several days of reading and resting on the psychiatric ward, with newly prescribed thyroid medication, antidepressants, prenatal vitamins and supplements coursing through her system, Loertscher felt ready to leave.
But while she had checked herself in, she could not check herself out. The county had put a “hold” on her.
The Taylor County Department of Human Services had issued a request for temporary physical custody under Wisconsin Act 292, dubbed the Unborn Child Protection Act.
Drug tests upon Loertscher’s arrival had shown “unconfirmed” positives for THC, methamphetamines and amphetamines. Later, the state would contend she knowingly used drugs and alcohol while pregnant; Loertscher would insist she stopped as soon as she learned of the pregnancy.
Today, 44 states and the District of Columbia have laws aiming to protect fetal development from drugs or alcohol.
Wisconsin is one of just five states that allow civil detention for pregnant people accused of substance use. Its legal proceedings take place out of public view, under seal, with a low standard of evidence and often a court-appointed attorney for the fetus — but none for the person gestating it. The law can require forced addiction treatment for the duration of pregnancy.
“The law is a means of allowing the (local health) department to begin working with pregnant individuals to help overcome challenges associated with various (alcohol or drug) concerns, limit the potential effects of continued use on the unborn child and receive necessary treatment and services to assist the individual towards recovery,” says Kay Kiesling, Outagamie County’s Children, Youth and Families manager. “This early intervention allows for a potentially safer
environment for when the child is born.”
But every leading medical association that considered these laws has condemned a punitive approach, saying it harms more than it helps. Pregnancy Justice, a legal advocacy group, says Wisconsin’s fetal protection law is the most “egregious” of the civil statutes in the country.
With abortion now largely inaccessible in Wisconsin, Act 292 could become more widely applied, worries Loertscher’s attorney Freya Bowen. The law applies to any “controlled substance,” even over the counter medications such as Sudafed, she says, and many people could fall under its purview.
Bowen fears that “really ugly enforcement” could prevent a pregnant person from leaving the state to obtain an abortion.
Once the court has exercised this jurisdiction, she says, “they’re free to do all kinds of stuff that are ‘in the best interests of the unborn child.’ ”
Case starts with visit to doctor
Loertscher’s legal entanglement began when social workers at the hospital and county worried that the drug use risked her fetus’ health and requested she attend residential treatment for substance use disorder. She refused because, she says, she didn’t have a dependency and had self-medicated in absence of affordable prescriptions. That afternoon, the county issued its hold.
“They said they were doing it for my baby,” Loertscher recalls, crying, in an interview with Wisconsin Watch. “But they were hurting him, too.”
Within weeks of the complaint, Loertscher would end up in jail.
Her case was one of 387 that year in which county child protective services “screened in” allegations of “unborn child abuse” across Wisconsin for further investigation, and one of 67 with “substantiated” claims that a pregnant woman had harmed her fetus by using drugs or alcohol.
Human embryos and fetuses — which the law terms “unborn children” — came under the auspices of Wisconsin’s Department of Children and Families in 1998. Amid the national “crack-baby” hysteria, politicians and press euphemistically called Wisconsin’s Act 292 the “cocaine mom” or “crack mama” law.
Legal scholars say such laws undermine pregnant people’s bodily autonomy — particularly for those who are poor or women of color who are more likely to be involved with the child welfare or criminal justice systems.
One woman, Alicia Beltran of Jackson, Wisconsin, even ended up in shackles in 2013 due to past drug use, despite testing negative for all substances except Suboxone, which she used to wean herself off Percocet, during her pregnancy.
Says Michele Bratcher Goodwin, a law professor at the University of California Irvine: “In terms of civil liberties, I mean, there’s nothing more extreme.”
About 400 cases a year
Since 2007, Wisconsin authorities have screened in an average of 382 complaints annually, meaning that about one pregnant person per day is investigated for unborn child abuse. But with limited publicly available data from the Department of Children and Families — and court records shielded from public view — it is unknown how many women, like Loertscher, have ended up incarcerated due to noncompliance. It is also unknown how many mothers have lost custody of their infants after birth because of the law.
Yet separation happens far too often, suggests one self-described “jaded” state public defender who only agreed to speak anonymously for fear of repercussions on her clients. She says Act 292 enables “the systemic kidnapping of children from women — and families, sometimes — who have struggled with addiction.”
A recent investigation by The Marshall Project, The Frontier and AL.com, co-edited and published in partnership with The Washington Post, found that since 1999, more than 50 women have been charged with child neglect or manslaughter after testing positive for drug use following stillbirth or miscarriage.
Since its enactment, Wisconsin’s fetal protection law has weathered two high-profile challenges. Loertscher’s legal team — which included now-Attorney General Josh Kaul — was most successful, securing a federal court ruling that deemed the law unconstitutional. But the win was brief, and due to a technicality, the law remains in effect today.
Loertscher’s case gives the public a glimpse at what can happen at its most extreme. While the law does not require county health officials and hospital workers to report such cases, a 2018 Pew study found Wisconsin practitioners “commonly” misinterpret their legal obligations — something researchers suggest the state should clarify.
War on drugs leads to ‘crack baby’ myth
In 1997, the Wisconsin Supreme Court ruled that a Waukesha juvenile court lacked authority to detain a pregnant woman at a hospital until childbirth on the basis of drug use. Not long after, a bipartisan group of lawmakers gave it that very authority in Act 292, which gave “unborn children” from zygotes to embryos full human rights — the only state to do so.
Bonnie Ladwig, a Republican representative from Racine who introduced the bill, testified: “Cocaine babies and children with fetal alcohol syndrome can be seen as abused children.”
Health professionals warned the fear of punishment would discourage pregnant women from seeking prenatal care and substance use treatment. Some suggested the law would incentivize women to get abortions to avoid detention.
And analysts — and even one of the co-sponsors — doubted its constitutionality. The nonpartisan Wisconsin Legislative Council and Legislative Reference Bureau advised that the liberty and privacy rights enshrined in Roe v. Wade and Planned Parenthood v. Casey would likely outweigh the state’s interest in “unborn human life before fetal viability,” according to the Collaborative for Reproductive Equity at the University of Wisconsin-Madison.
Writing in her book “Policing the Womb,” Goodwin, the law professor, says the media used anecdotal reports to fuel a hysteria over so-called “crack babies” — an ostensible “bio-underclass” doomed to lifelong suffering.
The racist crack baby myth cast Black, brown and Indigenous women as bad mothers and their infants as permanently damaged, Goodwin tells Wisconsin Watch. She notes that the former director of the National Center on Child Abuse and Neglect claimed — without evidence — that up to 15% of African American children would have “permanent brain damage” from gestational cocaine exposure, even though the majority of crack cocaine users are white.
“If this law had the face of middle or upper income white women at the time, it would not have been a law that would have won enactment or support,” Goodwin says.
A longitudinal study has since debunked the myth. Dr. Hallam Hurt, a neonatologist and pediatrics professor at Children’s Hospital of Philadelphia, followed children exposed to cocaine in utero for nearly a quarter of a century.
Hurt found no meaningful differences in development or cognition between the groups with gestational cocaine exposure and without. But both groups — all children from low-income families — performed poorly, leading Hurt and her team to conclude that poverty more powerfully influenced a child’s well-being.
A Wisconsin Watch analysis of DCF data found that today, Wisconsin child protective services disproportionately investigates allegations of unborn child abuse against Indigenous women, compared to their population size. The public defender says she represents a “very high” number of Native American women in Act 292 cases.
‘He is what gave me purpose’
Depression dogged Loertscher since elementary school, but antidepressants exacerbated her suicidal thoughts. She tried to die by overdose several times. A low point came when Loertscher passed out at a bar after drinking. A videotape surfaced showing her unconscious, being raped by multiple men.
That’s when Loertscher began self-medicating with methamphetamine. The stimulant “helped her to get out of bed in the morning,” according to a complaint later filed in federal court. Marijuana also mellowed her symptoms, which her attorneys contend she smoked “fewer than 10 times” that year.
Loertscher’s pregnancy by her then-boyfriend, now husband, compelled her to save her life — and her son’s.
“As soon as I found out that he was going to be a part of us, everything was for him,” Loerstcher says. “He is what gave me purpose.”
She says she disclosed her drug use in hopes of ensuring her son’s health and tried to explain her inability to afford prescription treatment to hospital staff.
“I was trying to self-medicate,” Loertscher says. “They didn’t care. It’s like, they had a certain set of protocols that they had to follow, and it’s like, erase the woman out of the equation.”
‘I don’t matter at all’
Less than 24 hours after Taylor County requested temporary physical custody, a social worker ushered Loertscher into a hospital conference room, where she listened into a court hearing on speakerphone.
On the other line were the court commissioner, corporation counsel, human services staff and another lawyer — court-appointed to represent Loertscher’s fetus. She lacked an attorney.
“It just kind of confirmed the feelings of ‘I don’t matter at all,’ ” Loertscher recalls.
Pregnant people going through Act 292 proceedings are eligible for state public defenders if they qualify by income. But Sandra Storandt, a social worker with Jackson County, says pregnant women in her county typically lack representation in this initial hearing because it happens so quickly — by law, within 48 hours of filing a request for temporary physical custody.
The authorities wanted Loertscher to remain at the hospital until “medically cleared” and then transferred to a licensed treatment facility. A center in Eau Claire, over an hour from her home in Medford, had availability. In Wisconsin, pregnant women get priority placement in substance use treatment centers.
A court transcript documents the hearing. Asked if she understood the hearing’s purpose, Loertscher said she would not answer questions without an attorney.
The court recessed in a failed attempt to find an attorney to represent her. Loertscher left the conference table and asked to make a call.
“I just followed Tammy down the hallway to her (hospital) room,” the social worker told the court. “She doesn’t want to be part of this.” The commissioner ruled that she had waived her right to participate, noting that they had limited time before they would have to release her.
At this point, authorities had another 24 hours.
A social worker went to Loertscher’s room, holding a phone so she could hear. The county called an obstetrician/gynecologist who claimed Loertscher admitted to knowingly using methamphetamine while pregnant. Prefacing that she was “not an expert witness,” the doctor explained some concerns around methamphetamine use during pregnancy, including low birth weight and possible learning disabilities and inattention to prenatal care.
In 2022, Pregnancy Justice reviewed numerous studies and reports about gestational exposure to various drugs, concluding, “Research tells us that there is no scientific evidence of unique, certain, or irreparable harm for fetuses exposed to cocaine, methamphetamine, opioids, or cannabis in utero.”
The doctor recommended residential treatment; the fetus’ attorney asked the court to force Loertscher into treatment “for this child to have a chance of literally being born.”
Afsha Malik, formerly a research and program associate at Pregnancy Justice, says Wisconsin’s “probable cause” standard means courts need only the “suspicion” of drug use to order commitment. The four other states which permit civil commitment — the Dakotas, Oklahoma and Minnesota — all require “clear and convincing evidence.”
The commissioner found enough evidence to detain Loertscher at the Eau Claire hospital until discharging her to the residential treatment facility.
Separation threatened
After the hearing, Loertscher says the hospital staff warned her she would lose custody of her baby as soon as it was born.
Storandt, the Jackson County social worker, says that in her county, the likelihood of a child staying with a parent is higher than their chance of removal, and separation isn’t always permanent.
But the state public defender practicing in northwestern Wisconsin, who spoke anonymously, says she’s seen newborns taken from parents “many, many times.”
This public defender estimates she handles about one Act 292 case per year. Unlike Loertscher, many of the clients are moms with prior involvement with the child welfare system. Their chief concern: “Am I going to be able to keep my baby after they’re born?”
The attorney says she’s seen foster care requests issued the moment a mom tries to take her infant home from the hospital, “even when I’ve had them make it through treatment, and the babies are born clean, and there’s nothing in their system.”
The conditions required to keep one’s children, or get them back, might appear simple enough: keeping regular contact with a social worker, attending supervised visits, taking parenting classes. But even these may be “unrealistic” for families without reliable transportation, a stable address or a working phone, the public defender says.
“Our system is not built to genuinely help parents, who are indigent, who are drug addicted, who are mentally ill, to actually comply with some of the conditions that counties and states want them to comply with in order to get their kids back a lot of times,” the lawyer says.
Deciding to fight
Loertscher, for the most part, resisted the process.
“I just found out that I was pregnant, and they were threatening to take him away,” she says. “I felt like I had to fight for the both of us.”
Two days after the hearing, Loertscher was supposed to transfer to residential treatment. She refused a blood test required for admission, and instead convinced the hospital to let her go home. She left with prescriptions for her thyroid and depression and plans to see a local nurse practitioner.
The discharge summary noted Loertscher didn’t think she misused substances, and that she “would like to keep the baby and that she would be caring for her pregnancy.”
At the courthouse, Loertscher’s case escalated. Taylor County’s corporation counsel requested to take her into immediate custody, and a judge agreed.
Over the next week, police twice attempted to arrest Loertscher to ensure her presence at court hearings. Loertscher’s family also tried to hire an attorney, but they could not afford the retainer fees.
So on Sept. 4, 2014, Loertscher appeared at her plea hearing without counsel. She disputed the county’s claims that she had committed unborn child abuse, setting the case for trial. If a jury determined her guilty with “reasonable certainty” by “clear, satisfactory and convincing” evidence, the court could detain her for the rest of her pregnancy.
That is, if she ever went to trial. But something else got in the way first. Finding she had violated an earlier court order to go into treatment by refusing the required blood test, the judge sentenced her to comply — or serve 30 days in the Taylor County Jail.
“I can’t have the deputies hog-tie you and take you to that treatment center,” the judge said. “That’s a decision you’ll have to make. But I can punish you if you decide not to obey that order.”
Hauled off to jail
Leaving the hearing, Loertscher reflected on her options: inpatient treatment or jail. Of the two, it was obvious which she’d prefer.
But accepting treatment also meant accepting a diagnosis with which she disagreed. It meant adopting an incorrect label — this time, “addict” — that someone else chose for her.
“They said they were going to put me in treatment and keep me there until I had my child, and then they were going to take him away,” she says. “So that’s where I’m like, ‘Well, I’m just going to have to go to jail then.’ ”
But jail brought its own risks, including missed prenatal appointments. The jail also refused to provide in-house care until she took a pregnancy test, which she initially refused. According to Loertscher’s eventual complaint, when a guard taunted her about taking a “piss test,” Loertscher lashed out.
She yelled obscenities through the closed door. The guard “grabbed” her by the arm, “tried to pull her out of the cell,” threatened her with a stun gun and then marched her into solitary confinement.
She spent about 36 hours in a “cold and filthy” windowless room with feces on the floor and walls. Her metal bed frame had only a “thin mattress and blanket” at night.
While in solitary, Loertscher says she received another threat. If she didn’t provide a urine sample, she’d remain locked up for the rest of her pregnancy and would have her baby there, which the National Perinatal Association warns is bad for the health of the child and parent.
Eventually, Loertscher found a number for the public defender’s office scrawled on a piece of paper by the phone. She called, and an attorney negotiated her release. She agreed to undergo an alcohol and other drug abuse assessment, comply with recommended treatment and pay for and submit to weekly drug tests, among other things.
After 18 days in jail, Loertscher went home. But she was far from free.
‘Born into chaos’
A week after she left jail, she received a letter from the Taylor County Department of Human Services, saying it had made a separate “administrative finding that she had committed child maltreatment” — a designation separate from her court case and consent decree.
“I had to protect us,” Loertscher recalls, “because what they were doing was so ridiculous.”
So she connected with Pregnancy Justice — then called the National Advocates for Pregnant Women — which teamed up with New York University School of Law and a Madison-area law firm. At the end of 2014, Loertscher filed a lawsuit in federal court, arguing she had been “deprived of liberty and numerous, well-established constitutional rights” after seeking health care.
A month later, during a weekly drug test, her water broke and Loertscher went into labor. At the hospital, she says staff questioned her about Act 292. A police officer stationed outside her room heard the same threat: if she did not cooperate, they would take her baby away.
Says Loertscher: “He was born into chaos.”
Her attorney raced from Madison to Eau Claire to intervene, but in the end, the hospital allowed Loertscher and her boyfriend to take Harmonious, their newborn, home.
“He is my everything,” Loertscher says. “I just want to make him proud.”
A court win — ‘then they took it away’
Over two years after Harmonious’ birth, the federal court ruled in Loertscher’s favor.
The court found that Act 292 implicated fundamental constitutional rights “to be free from physical restraint” and “coerced medical treatment,” and it was “unconstitutionally vague.”
Each element of unborn child abuse is wide open for interpretation, the judge noted. Its key terms “habitually,” “severe,” even “risk,” are all matters of “degree” that neither the statute nor departmental standards define. As a result, the law could be enforced against any pregnant person with a history of substance use disorder, he said, “regardless of whether she actually used controlled substances while pregnant.”
The state was immediately barred from enforcing Act 292 across Wisconsin.
“I felt like, at least it was for something,” she says. “And then they took that away.”
Within a week, Republican Attorney General Brad Schimel appealed the decision.
An appeals court panel ruled the injunction was “moot” because Loertscher had left Wisconsin two weeks after Harmonious’ birth, temporarily moving to Hawaii.
“I beat myself up so much,” Loertscher says through tears. “If I would have stayed in that shithole, it (ruling) would have stuck.”
The law remains in effect today.
At least one substantive change to procedure has been made, although it came before Loertscher filed her lawsuit. The Department of Children and Families no longer allows social workers to determine whether or not a pregnant person has committed “maltreatment.” Instead, they only determine whether or not to require “services,” such as counseling or treatment.
“I don’t understand how they can acknowledge that something is unconstitutional, but keep it going,” Loertscher says. “That makes it seem like our constitution doesn’t mean anything to certain people, like, certain people’s rights don’t matter at certain points.”
Wisconsin’s confusing standard
Fetal protection laws place pregnant people into a distinct legal class, says Malik, who at the time she spoke to Wisconsin Watch was with Pregnancy Justice.
While most drug-related offenses relate to possession or distribution, these laws punish pregnant women for use — even if these are legal substances, such as alcohol, which are lawfully obtained.
The behavior identified as unborn child abuse in Wisconsin falls under standards that even those charged with enforcing the law struggle to describe. It requires that a pregnant person “habitually lacks self-control” regarding alcohol or drug use. The habitual lack of self-control must be “exhibited to a severe degree” and create a “substantial risk” that the fetus’ — and eventually, the newborn’s — physical health “will be seriously affected or endangered” unless the parent receives treatment.
When asked by email to clarify what “habitually,” “severe degree” or “serious harm” means, Department of Children and Families communications director Gina Paige said the law “did not include any further language or define these terms.”
Enforcement varies by county. Only Dane, Jackson and Outagamie gave Wisconsin Watch insight into their procedures. Another county provided background information on its approach on the condition of anonymity. A social worker from Jackson provided an on-the-record interview, the others provided answers or statements via email. Officials from Brown and Ashland counties initially expressed interest in speaking but did not follow through with interviews or email responses.
Dane County says it “does not endorse” placing people in a “locked facility to force treatment” and instead favors harm reduction, which it did not define.
‘Being quiet about it isn’t helping anyone’
Seven years after the birth of her healthy baby boy, Loertscher, who now lives in Georgia, is still scarred by her entanglement with Act 292.
“They say that they’re doing it to protect the child, but in reality, at least in my situation, they didn’t care one bit,” she says. “It was all about, for some reason, proving that I was a bad person.”
The detention, incarceration and legal battle has left her with further anxiety and depression. Loertscher has found it difficult to trust anyone outside of her immediate family, leaving her unable to work and even afraid to drive.
The trauma she and her husband share manifests in overprotective parenting.
But in the last two years, around the time Harmonious began school, Loertscher felt something shift within her: “I finally was like, ‘You know what? I’m not going to let them take all my power away.’ ”
She started taking better care of herself, socializing more and giving interviews about her experience, because “being quiet about it isn’t helping anyone.”
“What they did didn’t break us, if that was what they were trying to do,” she says. “And our son turned out amazing. He’s smart and he’s happy.”
The 7-year-old is “like a little fish” in the water and loves to read with his mom, and tell her jokes he picked up from books.
His favorite, of late, asks: “What did the alien say to the vegetable garden? Take me to your weeder!”
Loertscher has a message for anyone else caught up in Wisconsin’s fetal protection law.
“I want to tell them that they can be brave,” she says. “They can come forward and they can say that what happened to them is wrong, because it was.”
If you or someone you know is struggling or in crisis, help is available 24/7. Call or text 988 to reach the 988 Suicide & Crisis Lifeline, or use the chat feature at 988lifeline.org.
The nonprofit Wisconsin Watch (www.WisconsinWatch.org) collaborates with WPR, Milwaukee Neighborhood News Service, PBS Wisconsin, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by Wisconsin Watch do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.
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POLICING PREGNANCY
Wisconsin’s law on substance use in pregnancy is wrong, leading doctors say
Practitioners say substance use during pregnancy should be treated like any other medical issue — not as a crime.
By Phoebe Petrovic
Wisconsin Watch
Every leading professional medical association that has considered the issue in the United States condemns approaches that punish pregnant people for substance use. In Wisconsin, Act 292 takes the opposite approach: The law can force people into treatment and even incarceration.
The law passed in 1997 amid a national “crack baby” hysteria, which in later decades was scientifically debunked. Longitudinal studies found that children exposed to cocaine in-utero did not vary cognitively or developmentally from children who were not exposed.
Each year since 2007, Wisconsin authorities have screened in an average of 382 allegations of unborn child abuse under Act 292 for further investigation. Wisconsin Watch spoke with two obstetricians with experience treating pregnant people with substance use disorder, along with leaders of one treatment facility, to explore what the state’s approach to this population could look like in the absence of Act 292.
Meta House, a Milwaukee-based facility that provides care to women with the condition, opposes the law. CEO Valerie Vidal says it reflects a “severe misunderstanding of substance use and mental health.”
That’s because substance use disorder is a chronic health condition affecting the brain.
“The laws themselves are criminalizing women who are sick, and ultimately damaging them more by potentially having them be traumatized by a civil detention, instead of getting them access to the care and treatment they may need,” she says.
Vidal points out the state does not act this way toward other health conditions that involve a component of personal decision-making and can affect fetal health, such as smoking cigarettes.
Dr. Kathy Hartke, an obstetrician and gynecologist, agrees. She currently co-chairs the Wisconsin Maternal Mortality Review Team, and previously chaired the Wisconsin Section of the American College of Obstetricians and Gynecologists.
Substance use disorder is “a medical disease that needs to be treated just like diabetes, high blood pressure, asthma,” she says. “We have to (help people recover) humanely — nonjudgmentally and with empathy — and we have to do it scientifically and not punitively.”
By using civil detention and forced treatment while failing to provide adequate support, Hartke says, “We’re doing all the wrong things.”
Hartke says one of the law’s flaws is “forced treatment,” which “doesn’t work.” Such actions also break trust between patients and providers, which she calls “critical.”
A 2019 statewide public opinion survey from the Wisconsin Department of Health Services found that people generally endorse “supportive” approaches toward those with opioid use disorder — except when it comes to pregnant women. The survey found “very high support” for forcing pregnant women into treatment.
Another flaw, providers say, is the law’s punitive approach can deter pregnant people from seeking prenatal and addiction care.
In 2018, a Pew Charitable Trusts study of Wisconsin’s substance use disorder treatment found that while there are no “systematic data,” clinicians and patients both reported that “fear of punitive action” under Act 292 potentially deters pregnant women from seeking both prenatal and substance use disorder treatment.
Some women told Pew the fear of losing their newborns or other children caused them to hide their pregnancies while seeking treatment, or to avoid treatment altogether. In all, Pew concluded: “This barrier potentially puts pregnant women and their child at greater risk of harm than they would be if this policy did not exist.”
Locked in the psychiatric ward
Hartke observed this effect firsthand. One of her patients was locked in a psychiatric ward under Act 292 — drugged with Xanax — although a physician said her opioid addiction did not pose a significant risk to fetal health. The patient was fired from her job, and her husband had to take leave from his. And during her next pregnancy, Hartke says, the patient avoided all prenatal care because she was so traumatized.
Act 292 also complicates relationships between pregnant people and child protective services.
The Pew study found that health care professionals, national and Wisconsin experts “generally viewed the involvement of child protective services as negative.” Outagamie County’s Children, Youth and Families manager Kay Kiesling acknowledged via email that families “often see CPS as a punitive agency,” and that they need to build “trust and connection” to successfully engage families.
Dr. Charles Schauberger is board certified in both obstetrics and addiction medicine, and he’s dedicated the past 10 years of his career to caring for pregnant women with substance use disorder in La Crosse, Wisconsin.
Schauberger, who is medical director for residential treatment at Gundersen Health System, believes the knowledge that CPS can remove an infant after birth can be a powerful disincentive to seeking treatment.
Hartke says she tries to get patients into therapy, assuring them she won’t turn them in. But she advises that if they or their infant test positive for substances around delivery, CPS could take their newborn — showing how avoiding treatment during pregnancy to evade the child welfare system can backfire.
Schauberger has researched custody rates for women using drugs while pregnant in which child protective services was involved. In his yet-unpublished study of his own patients, 93% of women using opioids took their infants home from the hospital, but only 60% maintained custody long-term. Only 67% of women using methamphetamines took their newborns home, and within five years, only 40% had maintained custody. Only 20% of women who lost custody ever regained it.
‘One-stop shopping’
Medical professionals say Wisconsin should invest in “wraparound” care in which different providers cooperate with one another to address the multiple medical and nonmedical needs. Schauberger favors “one-stop shopping” with obstetrics, addiction and pediatrics under one roof.
In general, he notes, the earlier a pregnant person can stop using drugs or alcohol, the better the outcomes for the fetus.
Eleven pregnant women with an opioid use disorder interviewed by the Wisconsin Association for Perinatal Care (WAPC) also recommended better communication among clinicians, according to a 2018 report, and non-judgmental providers to provide care “built on trusting relationships” and “focuse(d) on well-being.”
Schauberger says treatment should take advantage of patients’ natural motivation to stay healthy during pregnancy.
“We need to help them learn the skills that they need to be effective parents and productive members of society,” Schauberger says. “Social resources are vitally important and often lacking.”
WAPC crafted a “framework for comprehensive care” that includes help with medical and nonmedical realities: mental health, chronic health conditions, food insecurity, child care and safe and affordable housing. The Alliance for Innovation on Maternal Health also has guidelines for treating pregnant and postpartum people with substance use disorder.
Waukesha’s wraparound model touted
For the past several years, Hartke has worked with a coalition to develop and implement such a wraparound framework in Waukesha, called Wisconsin Women’s Health and Recovery Project (WHARP). It is described as a county-level “collaborative model for behavioral health, physical medicine, and social services” for cis- and transgender women at risk of substance use disorder and their families, including transportation, child care or housing.
“A lot of them end up homeless if they don’t have services,” she says.
Hartke was dismayed to hear that earlier this year, Marathon County rejected a Department of Children and Families grant for such a pilot project. It would’ve provided $327,100 over two years to fund three apartments for parents who had completed court-ordered rehabilitation and who were eligible to regain custody of their children — except for a lack of safe housing.
Kurt Gibbs, chair of the Marathon County Board of Supervisors, which rejected the grant, did not respond to requests for comment.
If WHARP is successful in Waukesha, Hartke hopes it can become a model for treating the symptoms and fixing the root causes of substance use.
And there’s something else she says the state could do to dramatically improve outcomes for pregnant people: extend BadgerCare coverage to 12 months postpartum. It currently lasts 60 days.
“Twelve months is what we want,” Hartke says. “Six to 12 months is a very dangerous time for postpartum women.”
Data reviewed by Wisconsin’s maternal mortality review board show this period is deadly due to hypertension, cardiomyopathy, postpartum depression, intimate partner violence, suicide and drug overdose, including what Hartke says is a “significant increase in overdose death in the first year after delivery.”
Gov. Tony Evers’ 2021-23 budget proposal included covering 12 months postpartum, but the Legislature cut that to three months. The state’s Department of Health Services has submitted a waiver to the federal government to extend to three months, but it has not yet been approved.
Treatment gap persists
As lawmakers and the public debated Act 292, critics noted the bill lacked funding for treatment programs. Rep. Bonnie Ladwig, R-Racine, who introduced the bill, dismissed those concerns in her floor speech, saying the law targeted people who refused treatment, not those who willingly sought it.
But the problems identified over two decades ago — a dearth of treatment programs and the high cost of those that exist — remain today.
“It’s fine for decision-makers to say, ‘Well, a pregnant woman using substances should get treatment,’ ” says Vidal, of Meta House. “Okay, but then how are you supporting that woman to navigate the various systems to get her into treatment, so that she’s not losing rights?”
Advocates for pregnant women contacted by Wisconsin Watch all said the state has a shortage of high-quality addiction treatment programs. The Pew study attributed that to the state’s “stricter” certification requirements for counselors who provide such services.
At Meta House, every counselor is dually certified in substance use disorder and mental health. Today, it has 35 beds for women and 15 for children. Its residential program often has a six-month waitlist. Vidal says Meta House plans to expand to serve more clients.
It’s expensive to provide this level of care: At Meta House, it averages about $450 per bed per day. Wisconsin’s Medicaid system reimburses substance use treatment between $99 and $250 per day. Referring counties sometimes reimburse room and board costs, and state grants partially — but do not fully — cover the rest, Vidal says.
Not everyone requires that level of care. Treatment can take many forms: inpatient, outpatient, group therapy, one-on-one counseling and/or medication assisted treatment. “In all types,” Schauberger says, “the demand exceeds the supply.”
For example, Sandra Storandt, a child protection services worker in Jackson County, says there are no inpatient programs in her rural county. The nearest program is in Eau Claire, 45 minutes away, followed by La Crosse.
Just a handful of programs, including Meta House, accept moms and children together. A pregnant parent who already has children might need to entrust them with a friend or relative, or child welfare officials will arrange for them to go to foster care.
Separation can traumatize both parent and child, says Christine Ullstrup, Meta House’s vice president of clinical services. Hartke adds that so long as children are in a safe situation, “infants that can stay with their mother do better.”
The nonprofit Wisconsin Watch (www.WisconsinWatch.org) collaborates with WPR, Milwaukee Neighborhood News Service, PBS Wisconsin, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by Wisconsin Watch do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.
What to do if you are pregnant and struggling with substance use in Wisconsin
There is currently no directory of Wisconsin-based doctors and midwives experienced in providing care to pregnant people with substance use disorder, says Dr. Charles Schauberger, who is board certified in both obstetrics and addiction medicine and has dedicated the past 10 years of his career to caring for pregnant women with substance use disorder.
Enforcement of Act 292 varies depending on the county where one resides. But Schauberger’s experience tells him that “if a care team has the reputation of working hard to keep patients in treatment and providing great prenatal care, county health authorities, including CPS, are much more likely to back off.”
Schauberger offered this advice for pregnant people with substance use disorders:
- Begin prenatal care as soon as possible. This will be safer for you and your baby.
- Don’t delay treatment or attempt to hide your pregnancy.
- Be selective about whom you see for prenatal care, seeking out medical providers experienced in caring for women with substance use during pregnancy. Drug treatment programs and other women who have used drugs and had recent pregnancies may be good sources for referral.
Pregnancy Justice has created a fact sheet for healthcare providers and pregnant people, and offers this advice in a know your rights sheet:
- Consider speaking to an attorney or visiting the group’s birth rights guide (English and Spanish) before disclosing past drug use to your doctor.
- Contact Pregnancy Justice at 212-255-9252 or bit.ly/GetHelpNAPW if you are accused under Act 292 and need free legal advice.
— Phoebe Petrovic
