Lola Lieb entered the world battling a dependence on Methadone inherited from her mother, a circumstance both familiar and troubling to some Milwaukee area doctors.

"The number of methadone-withdrawing babies has skyrocketed in the last four to five years," said John Glaspey, a pediatrician and neonatologist who works at several area hospitals for Newborn Care Physicians of Southeastern Wisconsin. "The problem right now is much worse than it ever was before."

No one is sure just how often Milwaukee babies are born undergoing Methadone withdrawal.

"The short answer is: too often," said Stephen Ragatz, medical director for the neonatal intensive care unit at Wheaton Franciscan Healthcare-St. Joseph. "We currently have four babies withdrawing from Methadone in our NICU."

Lola left the world battling Methadone too. She died last Oct. 29 at the age of 3 months.

In the hospital, she had been given Morphine and phenobarbital, a common treatment for babies undergoing Methadone withdrawal. Gradually she had been taken off the morphine.

Yet the autopsy attributed her death to acute Methadone intoxication. A bottle she had used shortly before falling asleep on her final day was found to have traces of Methadone, according to a criminal complaint filed Wednesday against the mother, Andrea P. Zalewski. The complaint charges Zalewski with one count of child neglect resulting in death, punishable by up to 25 years in prison.

Before death, when Lola still lay growing in her mother's womb, she occupied a crossroads of modern medicine, a place where some doctors believe the health of a woman and the health of her baby may diverge.

A complex calculus goes into medicating a pregnant woman with methadone.

"Any medication during pregnancy has risks and benefits," said Karol Kaltenbach, director of Maternal Addiction Treatment Education and Research at Jefferson Medical College in Philadelphia. "The rationale that goes into this is that if a woman is dependent on opioids, Heroin, she's using drugs and exposing the fetus to those drugs. She's subjecting the fetus to continued episodes of withdrawal."

A mother addicted to Heroin is unlikely to obtain the drug often enough to avoid withdrawal. And the stress of withdrawal can lead to stillbirths. Even weaning a pregnant mother off of Methadone can lead to stillbirths or miscarriages.

"Methadone is really a harm reduction strategy," said Bawn Maguire, coordinator of a Methadone program for pregnant women at the Magee-Women's Hospital of the University of Pittsburgh Medical Center.

Safer than heroin

Though highly addictive in its own right, Methadone is considered safer than Heroin for a pregnant woman. The woman knows what she is getting, which is often not the case with a bag of Heroin purchased on the street. She does not have to engage in risky behaviors to get the drug. Health care workers control the dose she receives.

Moreover, women taking Methadone are considered more likely to report for neonatal visits and to seek counseling, Maguire said.

Still, others see a significant downside to the drug.

"It's controversial whether women should be on Methadone," said Mark Kostic, associate medical director of the Wisconsin Poison Center, explaining that the drug is thought to be responsible for babies' being born smaller and with respiratory problems. "You're substituting one addiction for another. It's primarily because the mother can function better on it."

Not all mothers using Methadone, however, are taking the drug to escape from heroin. Today Methadone is being used increasingly by patients with chronic pain as a substitute for drugs such as Oxycontin and Vicodin.

Higher doses

Another change has troubled doctors. Pregnant women are taking much higher doses of Methadone than they once did.

"When I started in the field we never saw anybody on more than 60 milligrams a day of Methadone," said Glaspey, who began his career 30 years ago. "Now we rarely see anybody under 120 milligrams, and we've seen some up to 320 milligrams."

In fact, a woman who is on Methadone and then becomes pregnant will almost certainly see her dose increase. Mitchell Parchem, director of the North 27th Street Clinic, confirmed that pregnant women usually receive a higher Methadone dose.

"The explanation that I've been given," he said, "is that as the pregnancy progresses, the woman's body mass increases. The dose has to be increased to prevent withdrawal."

Another reason doses may be much higher today is that street Heroin has become much more potent. In the 1960s, Heroin was about 8% to 10% pure; today it can be 70% to 90% pure, Kaltenbach said.

Not every baby born to a methadone-addicted mother goes through withdrawal, but many do.

They are often jittery with an excessive, high-pitched cry. They have difficulty feeding. They scratch themselves and suffer tremors, vomiting and diarrhea.

"These babies are at times inconsolable," said Ragatz of Wheaton Franciscan Healthcare-St. Joseph.

Typically, hospitals must stabilize the baby with Morphine after birth. They keep the babies swaddled in dark rooms with little noise, as calm a setting as possible. And they administer Morphine and Phenobarbital -- "we are very careful with the amounts of both medications," Ragatz said.

Hospitals use a detailed scoring system to measure the babies' distress. Only when the scores drop below certain benchmarks will doctors decrease the medication.

The entire process can take months.

And the system is not perfect. Ragatz said communication must improve between doctors at the Methadone clinics and those at the hospitals where the mothers have their babies.

"I wish there were a way we could have a more unified approach," he said.