There’s a largely hidden epidemic in Montana, and the United States overall, of babies coming into this world addicted to powerful drugs such as opioids and methamphetamine because their mothers used the substances during pregnancy.
Dr. Deborah Reed-Thurston, the neonatologist at Providence St. Patrick Hospital in Missoula, has seen these babies convulse so badly they shake their entire crib. They cry inconsolably, their arms are often stiff and they don’t sleep or feed well. They’re also prone to seizures and weight loss and are at risk for behavioral and neurological problems later in life, she said.
Substance abuse disorder during pregnancy is associated with premature birth, infections, stillbirth and a number of fetal malformations. Mothers who use drugs while pregnant are also much more likely to have their children taken away and put in foster care.
The problem is getting worse, as the rate of babies born with Neonatal Abstinence Syndrome, as it is called, quadrupled from 2000 to 2015 to the point where an infant with withdrawal symptoms is born every 25 minutes in this country, according to the federal Centers for Disease Control. At Community Medical Center in Missoula, babies born addicted represent 10 percent of all admissions to the Neonatal Intensive Care Unit.
Now, to combat the problem, the two competing hospitals in Missoula, CMC and St. Pat’s, are joining together to create unified screening standards, and both will cooperate to develop a comprehensive program to improve care for pregnant women struggling with substance use.
Both hospitals are trying to raise awareness that women who are using these drugs can get confidential, safe treatment (including prescribed methadone to prevent withdrawal) from the time they find out they are pregnant all the way through delivery and afterward to help them improve the health of their baby, get clean and reduce the chances of losing their kids to foster care. The number of children in foster care in Missoula County has doubled from 124 in 2012, to 268 in 2016.
Each hospital has received a $150,000 grant from the Montana Health Care Foundation to care for women as part of the Solving Perinatal Drug and Alcohol Use initiative, a collaboration with the Montana Department of Public Health and Human Services.
Dr. Bradley Holbrook, a maternal fetal medicine physician at CMC, said medication-assisted treatment along with counseling and behavioral therapies can lead to a lasting recovery. He said the hospital has strict confidentiality with patients and won’t cut them off from drugs if they’re addicted, because abrupt discontinuation of opioid use during pregnancy is not recommended and can result in premature labor, fetal distress and miscarriage.
There’s also a greater risk of relapse and overdose deaths, which is why withdrawal should by managed by physicians who have experience in addiction during pregnancy, he said.
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“Prescribed methadone during pregnancy improves prenatal care, reduces illicit drug use, and minimizes the risk of fetal in utero withdrawal,” he said. “When paired with counseling it has been shown to more than triple the chance of successful recovery.”
The hospitals will use pharmaceutical-grade methadone, which is safer than street drugs and will be administered in a sanitized way to prevent disease. Patients will get regular dosages so they won’t be on a roller coaster of cravings, and they won’t have to resort to other illegal behaviors to acquire street drugs.
Dr. Bonnie Stephens, a neonatologist and development-behavioral pediatrician at CMC, said the goal is to reduce the shame and stigma that is wrongly associated with pregnant mothers. Too often, she said, substance abuse disorder is treated as a crime instead of an illness. That further perpetuates the mothers’ addiction, places their children at risk of discrimination and can lead to inappropriate child welfare interventions.
“It is important to not vilify pregnant women and mothers with SUD. Moms need treatment, and they need to be supported so they can recover from addiction and care for their babies,” Stephens said.
She added that while NAS is treatable, ideally, healthier pregnancies and better outcomes for families are achieved by ensuring women of childbearing age have better access to effective birth control methods. She said it’s also important to engage women of childbearing age who have substance use disorders to seek treatment before they become pregnant.
The hospitals will collaborate on a unified screening process so that, for example, a soccer mom who got in a car accident and became addicted to pain pills during recovery will understand that she’s addicted and her unborn child may be in danger. Physicians at both hospitals estimate that vast numbers of drug-addicted mothers who come through aren't identified as having a problem and are sent on their way without treatment.
“As physicians who care for mothers and their newborns, we are committed to help mothers receive the supportive treatment for opioid dependence before and after delivery,” said Dr. Reed-Thurston at St. Pat’s. “We are confident that building this program will give women tools, resources and hope for themselves, their baby and their families.”
For more information visit https://mthcf.org/focus-area/behavioral-health/solving-perinatal-drug-alcohol-use/.