On Tuesday, Brittany makes a familiar trip to the university hospital. She has been going to a special clinic for mothers with opioid addiction and today, she plans to show off the chubby cheeks of her 8-month-old son Aiden.
It’s a simple moment of happiness after months of hard work.
Like many women, Brittany’s addiction started with painkillers and progressed quickly. A combination of untreated depression, familial vulnerability, and easy availability of narcotics and heroin in her community quickly swept Brittany into the opioid epidemic that has affected thousands of Americans. When she became pregnant, she knew she needed help.
Unfortunately, addiction treatment for pregnant women can be hard to obtain. Some providers consider pregnant women too high-risk, and there is a great deal of misinformation about which treatments are safe during pregnancy. Moreover, stigma and fear of legal repercussions prevent many women from seeking the care they need. Brittany floundered in the first few months of her pregnancy, but finally found her way to a clinic specializing in maternal opiate addiction in her 34th week.
The statistics about opioid addiction during pregnancy are grim: a 5-fold increase in opioid use during pregnancy over the past decade, accounting for approximately 0.8 percent of all pregnant women, more common than blood clots or maternal heart disease. Babies born to mothers abusing opioids are at risk of being born premature, being too small, or having neonatal withdrawal symptoms. Most strikingly, women were dying: between 2007 and 2016, the percentage of maternal deaths caused by opioid misuse more than doubled from four percent to 10 percent. In 2017, America lost more people to opioids than the entire death toll of the Vietnam War, and pregnant women were no exception.
Best practices support treating addiction as a chronic disease, rather than as a moral failing. At Brittney’s clinic, the guiding philosophy was that all mothers do the best they can and that mothers deserve to be supported no matter where they are in their recovery journey. No mother should turned away from care and all mothers should be treated with respect.
Specialty perinatal addiction clinics tend to be patient-centered, comprehensive, and conveniently located in one space. Ideally, moms see the same team members over and over again, and have access to prenatal care and addiction treatment in the same appointment. Clinics may offer access to social workers, mental health specialists, maternal fetal medicine specialists, legal advocacy, community liaisons, and more. Needs that cannot be met on site are typically referred to outside organizations. As women approach their delivery date, they should be given the opportunity to discuss birth plans, breastfeeding, pain management, and birth control. Pre-delivery consultation with pediatric specialists who care for babies with opioid withdrawal can help empower and prepare mothers to play an active role in their baby’s recovery. Postpartum, mothers should continue medical care for at least the first year, as this is a particularly high-risk time period for depression and substance misuse.
After meeting with her doctor, Brittany started treatment with buprenorphine, a medication that leads to less neonatal withdrawal severity than the traditional option, methadone. She was also finally treated for the depression that escalated her opioid addiction in the first place. If she ran into obstacles, the team helped her troubleshoot. A month later, she delivered a healthy full-term boy, heroin-free.
Addiction care is slow medicine – there are gains, there are losses, and there is no one-size-fits-all solution for individuals grappling with a serious and lifelong condition. With evidence-based care and a compassionate approach, though, the trajectory leans toward positive.
If you or someone you know is suffering from opioid addiction while pregnant, let them know that they deserve great care, and that clinics like the one Brittany found exist to help them.
Lulu Zhao, MD, FACOG is an assistant professor in the Department of Ob/Gyn and Behavioral Ob/Gyn at University Hospitals (UH) Cleveland Medical Center. In 2018, Dr. Zhao started the UH MOMS clinic at the UH Rainbow Center for Women and Children to enable women to receive prenatal care and addiction treatment simultaneously. All names and identifying information have been modified to protect patient privacy.
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