Your Family Matters: How mothers and babies are being treated for opioid use disorder
Pregnant women and new moms with substance use disorder undergo treatment with not only their best interest in mind, but also their baby’s.
Dr. Kimberly Simcox is an addiction medicine specialist and OB/GYN at Carilion Clinic. She’s waivered to see up to 100 patients at any given time, and the standard of care is something called medication assisted therapy.
“Women with opioid use disorder during pregnancy, we do not recommend that they go off of their medications if their bodies have become dependent on it, because they can suffer from acute withdrawal, and that can be very dangerous to both the mother and the fetus,” Dr. Simcox said.
What that means is these women are placed on medications used to curb cravings and keep them from withdrawing. Those medications include buprenorphine and methadone.
“So we keep the pregnant patients on those medications throughout their pregnancies, we follow them very closely, and then we continue their care until they’re at a stable point in their lives, when they could potentially ween off those medications. But often as we find in opioid use disorder, people are on those medications for life long,” she said.
Simcox compares the disorder to a diabetic taking insulin.
“We need to normalize this and treat it as any other chronic disease in pregnancy. It’s just as prevalent. These women are trying to get help. They don’t say ‘I want to take pills or I inject heroin during pregnancy’ they don’t say that, nobody says that, nobody wants that right? We don’t know what anyone else is going through,” said Dr. Simcox.
And that’s one of the things that Dr. Jacinda Hayes has found. She works directly with the babies in a new transitional nursery.
“The moms just feel so guilty. They will start weeping while they’re holding their baby, and it’s just heartbreaking because they love their baby and they just feel so guilty and they share that with us,” said Dr. Hayes. “And that’s one of the hardest things for me, it makes me want to start crying because they feel so bad, they’ll say things like ‘I did this to my baby.’ And I’ll reassure them that ‘but you’re in a treatment program, you’re here, you’re with your baby, you’re taking care of your baby…imagine where you or your baby would be if you weren’t in a treatment program?’”
This new unit she works with to treat the babies opened up about four months ago on the same floor of the mother/baby unit, and Hayes says that’s for a very specific reason.
“The mom is the number one treatment for baby.”
They’ve adopted a new program developed by Yale called “eat, sleep, console,” which incorporates more of that mom-is-best philosophy.
“If the baby is not eating great, not able to sleep at least one hour, and not consolable within 10 minutes, if they get fussy, well then we know, ok that’s because of withdrawal. And they do need some medication,” said Dr. Hayes.
They also use this space instead of the NICU setting because it’s less stimulating; dimmed lights, no beeping monitors, sound-absorbing tiles, and rocking chairs. But again, they encourage the mother to be the key factor in helping baby transition.
“These babies are not born addicts. They’re not born with addiction. What happens is during pregnancy, when they’re in mom’s belly they get exposed to medications or substances. They’re born, umbilical cord is cut and they no longer have that exposure, so they go through a withdrawal process,” she said. “So doesn’t mean they’re going to be addicted, or have issues with addiction later in life, it just means they’re going through a transition time where they’re at risk for having withdrawal.”
Hayes’ goal is to prevent that withdrawal from happening at all, or lessen it. And it’s working. The babies being born by mothers with substance use disorder are healthier, they have higher birth weights, and are going to the NICU less and less.
“We’ve had 33 babies in our transitional nursery, and we’ve only had to send one baby up to the NICU to be started on methadone,” Dr. Hayes said.
The kind of partnership between physicians promoting prenatal education and counseling in addition to medication assisted therapy is paying off.
“People do think that we’re just substituting one addiction for another when we we’re putting a patient on buprenorphine or methadone, but it is not that at all,” said Dr. Kimberly Simcox. “We’re helping that patient not feel ill. If you’re going through acute withdrawal, you’re not going to be able to get out of bed to take your kids to school or go to work, or be productive members of society. So you need a medication that’s going to help you not feel ill while you get your counseling and you learn more about the recovery process.”
“As we learn more about addiction and how it’s impacted our area, me included and our staff, are realizing this can affect anybody,” said Dr. Jacinda Hayes. “Addiction knows no boundaries, it affects people from all walks of life. And so we really try to make this a judgement free zone and we’re going to take care of you just like we’d take care of any other patient.”
The Roanoke-based Carilion Women's OBOT program just opened up. This will provide medication assisted therapy, on-site therapy, and a clinical coordinator to help each patient develop a plan for individualized care.
Pre-natal education, smoking cessation, and breast feeding counseling will also be included in this program for women and families.