Clinic programs address opioid use disorder during pregnancy
The trend was a steady increase in the number of newborns experiencing symptoms such as diarrhea, shaking, breathing problems and excessive fussiness.
The infants were suffering from neonatal abstinence syndrome, or withdrawal from drugs they had been exposed to in the womb from opioid use disorder.
Women in the program have access to prenatal care, individual counseling with a social worker, recovery support groups and a provider who can prescribe medication like buprenorphine, a medication-assisted treatment to help patients reduce or quit using heroin or other opiates.
The program is helping many pregnant women overcome addictions that started after physicians prescribed opioids to treat pain.
In some cases, women start buying heroin off the street after prescriptions run out.
Catholic Medical Center is among a growing number of hospitals launching programs specifically geared to help pregnant women who are struggling with opioid use disorder. The number of these women more than quadrupled from 1999 to 2014, according to the Centers for Disease Control and Prevention.
Researchers found the national prevalence of opioid use disorder increased from 1.5 per 1,000 hospital deliveries in 1999 to 6.5 in 2014. The annual rate increases were highest in Maine, New Mexico, Vermont and West Virginia.
Innovative approaches to treating withdrawal from opioid use disorder
New patients initially meet with a social worker, who gather information about the patient’s history and collect a urine sample to screen for drugs.
Then patients meet with a nurse practitioner, who can prescribe medication-assisted treatment. The staff completed a four-month training to learn about motivational interviewing, trauma-informed care and how to provide care to newborns with neonatal abstinence syndrome.
One common misconception the providers address with patients is the belief that women should stop using illegal opioids during pregnancy.
Stopping abruptly could cause withdrawal and potentially put the pregnancy at risk, instead, they encourage women to come in and get the support they need to start taking prescribed medication that can help with the cravings.
The Roots for Recovery staff also have been trained to use the eat, sleep, console approach for infants with neonatal abstinence syndrome. In this model of care, these babies can stay with mothers rather than transferring to the neonatal intensive care unit, where they often receive morphine to treat withdrawal symptoms.
Instead, nurses encourage breastfeeding, skin-on-skin contact, supplemental feeds and other comfort measures to help the babies through the withdrawal period.
The model has been so successful that 86% of babies with neonatal abstinence syndrome did not require medication in 2018 — compared to 18% seven years ago. The length of stay for the infants also has dropped from 15 days to six days in the hospital.
Creating a safe place for pregnant moms with opioid use disorder
It is critical to be aware of the shame many women experience.
They feel an immense amount of guilt, and many who come into the healthcare setting feel so much judgement. It was important to break down the barriers between moms and the healthcare team.
To facilitate trust with patients, nurses emphasize that moms play an essential role in caring for their babies, and nurses are partners in supporting the babies.
“A lot of the women have been beaten down for years, and they do not think they are worth anything.
Many did not have loving parent models, and they do not know what to do. Brayton shows patients how babies react differently to moms than to healthcare providers, and she affirms their decisions to keep their babies safe by getting help.
By participating in the program, women have access to:
- Medication-assisted treatment
- An intensive outpatient program
- Group therapy with other moms and pregnant women
- Individual counseling
- Support to find housing, transportation, insurance and employment resources
The patients also meet pediatricians who are trained to work with moms in recovery once the babies are discharged from the hospital.
How to reach more women facing opioid use disorder
Although hospitals are increasingly developing programs to help pregnant women with opioid use disorder, researchers are finding evidence that many of these women are not accessing programs to get help.
More than two-thirds of women in state prisons enter the system with drug dependence or abuse, according to the Bureau of Justice Statistics.
Mothers who enter the correctional system earlier deliver healthier babies because these women receive the food, shelter and safety they may not have access to in the community. It’s shameful that our society is not reaching these women. Many of the pregnant women have multiple children who are in foster care or living with family members.
The class in prison is often the first time they’ve had any type of prenatal education. If they were using, they want to know if the drugs will hurt their babies. This is an opportunity to be a healthcare provider who can give them hope.
