Jessica King's daughter was in the intensive care unit. The newborn was twitching, and doctors were monitoring her for symptoms such as vomiting and sweating.
King, 35, felt devastated to see her daughter this way. She was also gutted by guilt that her actions had put her there.
"I just remember thinking, 'I'm either going to let this consume me, the guilt and the shame, or I'm going to move on, and I'm going to keep trying to do the next right thing,' " said King, who battles with opioid addiction, which can include heroin, fentanyl and prescription pain relievers like oxycodone.
In May, first lady Melania Trump highlighted the impact of opioids on newborns and their mothers as part of her new Be Best campaign. The campaign focuses on children's well-being, social media use and the impact of opioid abuse on children. The initiative promises to support families, including supporting healthy pregnancies.
In Chicago, the number of those pregnant and giving birth while addicted is increasing. State health officials are monitoring babies with neonatal abstinence syndrome, drug withdrawal that occurs among opioid-exposed infants. Symptoms include seizures, dehydration and poor feeding; it can also mean poor fetal growth and preterm birth.
Between 2011 and 2016, the Illinois Department of Public Health noted a 53 percent increase in the number of babies affected; in 2016, the department recorded 391 of these newborns. On average, those babies stayed in the hospital for 13 days, compared with most babies' two days, according to Health Department data.
State doctors and other health officials are working to find how to best treat moms and babies. In 2015, the legislature passed a bill creating the Neonatal Abstinence Syndrome committee, which develops protocols and makes recommendations to improve the outcomes of these pregnancies.
Babies are often placed in a neonatal intensive care unit. "It turns out that that's probably not what's best with NAS babies," said Shannon Lightner, deputy director for the Health Department's Office of Women's Health and Family Services. Hospitals are now trying to avoid putting babies experiencing opioid withdrawal in places with bright lights and other crying newborns.
Instead, they're being kept with their moms when possible for bonding and breastfeeding.
Lightner said the committee also is working with the Illinois Perinatal Quality Collaborative, which aims to improve the health of pregnant women, moms and babies, to create focus groups of moms addicted to opioids.
But she acknowledged the challenges providers may face after identifying a pregnant woman in need of help with her addiction. "I think there's a lot of misunderstanding of how to treat pregnant women," she said.
The committee's annual report, released in March, notes inconsistent feedback from providers on screening, interventions and treatments. For example, less than 50 percent of eligible pregnant women addicted to opioids nationally receive medication-assisted treatment during pregnancy, the report shows. Detoxing during pregnancy can harm the baby.
King's addiction started in high school. One night, she asked a friend for ibuprofen, and he replied, "I have something else." He had a powder folded up in foil, which led to a decade of heroin use for King.
"It made me feel euphoric," she said.
During her junior year, she became pregnant and gave birth to her son, now 18. After graduation and through her 20s, she estimates she went through 13 different attempts at rehab. She also had a daughter, now 9.
Her parents cared for her children, telling them, "Mommy's sick," when she was gone or high. And her parents tried to care for her. They let King live with them, she said. Eventually, they practiced tough love and kicked her out.
"If love was enough, I would have gotten sober then," she said.
After time in prison for aggravated battery, King ended up at Gateway Alcohol & Drug Treatment on a court-mandated order.
After her release from treatment, she met and began dating her now-fiance. She relapsed five months later and began hiding her heroin use from him.
"The next thing I know I'm seven months pregnant, and I'm shooting about $100 a day of heroin," she said.
She felt, she said, as though she couldn't seek help. She thought, "Everyone's going to know, and everyone's going to hate me."
One Friday, she shut off her phone and disappeared to an Aurora hotel to use all weekend. Her boyfriend hadn't known, but now he did. He was terrified for her safety and for their baby.
She told her obstetrician, who began to wean her off drugs. Eventually, she pieced together a few days, a few weeks and then two months clean by the end of her pregnancy.
King gave birth in September 2014, in a room where doctors and nurses were on standby for a baby they knew might have neonatal abstinence syndrome. The birth went well, but a few days later, the doctor explained that her daughter was showing signs of withdrawal.
"At that point, the fear, everything, really kicked in," she said. King and her daughter's father stayed by their baby's side, sleeping on chairs.
"You could sense the judgment from the nurses, of course," she said, adding, "I would have judged. I was judging myself."
Now 3, her daughter is a boisterous toddler. King sometimes wonders whether hyperactive behaviors she sees are rooted in her opioid use while pregnant, or simply because she's a toddler.
"Life is OK," said King, who plans to marry next year. "It's not perfect. But this is life."