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The penalties are exceptionally stiff: 1 to 10 years in prison if her baby suffers no ill effects, 10 to 20 years if her baby shows signs of exposure or harm, and 10 to 99 years if her baby dies.

The goal of the law is to protect children by removing them from unsafe settings and mothers too impaired and unstable to provide proper care.

Finally, she reached for the other half of the tranquilizer.

They were able to identify 479 women who had been charged with chemical endangerment for in-utero drug exposure—about a quarter of all women charged under the law.

Because court records do not always indicate a pregnancy, and because juvenile cases are not included, the total is likely to be an undercount.

Shehi said the pediatrician reassured her, “Everything’s cool.” The next day, Shehi and the baby went home, and someone from the Department of Human Resources, the state child welfare agency, paid a visit.

In recent years, Alabama authorities have been aggressive about removing newborns from the custody of mothers who abuse drugs, typically placing a baby with a relative or a foster family under a safety plan that can continue for months or years.

Shehi had run afoul of Alabama’s “chemical endangerment of a child” statute, the country’s toughest criminal law on prenatal drug use.

Passed in 2006 as methamphetamine ravaged Alabama communities, the law targeted parents who turned their kitchens and garages into home-based drug labs, putting their children at peril.There are no standards for law enforcement officials or judges to follow: Is the presence of drugs in the mother’s body cause for charges if the baby tests clean?What test results are appropriate for medical providers to report, and when?James was born in August 2014, remarkably robust even though he was four weeks premature.But as the maternity nurse at Gadsden Regional Medical Center took the baby from his exhausted mother’s arms, Shehi felt a prick of dread. One night a few weeks earlier, Shehi and her ex-husband got into a huge argument on the phone.Prosecutors contend the law has been the impetus for hundreds of women to get treatment and restart their lives, with prison as the price for those who choose not to or who fail.

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