By SARA ARTHURS
If you’re pregnant and using opiates, Dr. Allison Westcott wants you to seek medical care — without shame.
“Just call us,” she said. “We will get you in. We want to take care of you.”
Westcott is among the medical professionals involved in a new Maternal Opiate Medical Support (MOMS) project, a collaboration by Blanchard Valley Health System and A Renewed Mind, which provides addiction and mental health services.
The project has received financial support through United Way of Hancock County and the Findlay-Hancock County Community Foundation. The Hancock County Board of Alcohol, Drug Addiction and Mental Health Services was also involved in launching the program, which is modeled after similar efforts elsewhere in Ohio.
Westcott, an OBGYN at Blanchard Valley’s Women and Children’s Center, said some mothers-to-be are “very afraid to come in,” worrying that if a doctor finds out about drug use, the baby will be taken away.
“I want to debunk that myth,” Westcott said.
If the mother is getting prenatal care and seeking help for her addiction, she’s more likely to get to keep her baby, the doctor said.
Not getting prenatal care is dangerous even if the mother isn’t using drugs, and more so if she is. It can lead to prematurity, lower birth weight, long-term stays in the special care nursery, and even the death of the mother or the baby.
Westcott said the Women and Children’s Center gets calls “all the time” about women who are using drugs and not seeking prenatal care.
“These moms are going through a lot,” Westcott said.
The women know, deep down, that they shouldn’t use drugs during pregnancy, and they feel guilty, she said. But addiction can overpower that.
Another obstacle is that it can be hard to find medical professionals willing to treat these patients. In the past, area doctors had to refer such mothers to treatment in Toledo, Lima or Defiance, Westcott said.
Dr. Patrick Bruno, medical director for A Renewed Mind, was originally an OBGYN who is now also board-certified in addiction medicine.
Bruno provides medication-assisted treatment as part of MOMS. The women get a prescription, usually for buprenorphine, a medication which keeps the mother’s — and baby’s — body from going into withdrawal.
Stopping an opiate cold turkey is dangerous for the fetus.
“There is a risk of the baby dying on the inside,” Westcott said.
The medicines used in medication-assisted treatment “do not cause euphoria,” Bruno said, so the person taking them doesn’t feel compelled to use more and more.
Women in MOMS also receive individual and group counseling. Bruno said women have exchanged numbers and formed friendships through the group. Some have gone to each other’s baby showers, he said.
“They have a common goal,” he said. “They all want to be good mothers.”
Brittany Strausbaugh, clinical nurse manager for the special care nursery and well baby services, said the mothers are learning through word of mouth about others who have complied with treatment and have, in fact, not had their babies taken away.
Westcott and her colleagues pledged to help women through OBGYN appointments without judgment.
“There’s no guilt or shame,” said Nicole Schroeder, supervisor of the Women and Children’s Center.
Glenda Renz, director of women’s health, encouraged families and friends of pregnant women to be aware that MOMS exists, and spread the word.
Schroeder said the existence of MOMS alleviates what had been a difficult position for health care providers — not wanting to tell the mother to keep using drugs, but also being aware that stopping and going into withdrawal could harm the baby.
Westcott said about one in three moms who are using heroin also have hepatitis C, a liver disease which can be transmitted through intravenous drug use. There is a risk that the baby, too, will get infected. Strausbaugh said these babies get extra followup care until they are 18 months old.
The women in MOMS must comply with what is asked of them. If not, Child Protective Services may get involved.
But Dr. Susie Grace, a pediatric hospitalist, said even if a baby is taken away, it’s generally not forever. The mother “has to have a safe home,” and must be clean and sober.
Every mother gets a urine drug screen upon delivery at Blanchard Valley Hospital, something Westcott said is routine at most hospitals. If the mother tests positive for drugs, they try to get her into treatment.
But they want to do so earlier.
Westcott said opioids are a central nervous system depressant. They make babies groggy, just like adults, and can inhibit their development. Persistent use can result in small babies, developmental issues and cognitive impairment.
It takes a smaller quantity of drugs for a fetus to become dependent. Strausbaugh noted that this is different for babies than adults. “They’re dependent on the drug,” as opposed to “addicted,” she said.
Grace said babies who are born to mothers who are using may go into withdrawal.
Just as a baby gets nutrients through the umbilical cord, he or she gets opiates the same way. When the cord is cut, “We then see the baby suffer,” Grace said.
The most severely affected can have seizures. Other common problems are poor feeding, weight loss, diarrhea, poor bonding and not sleeping well.
Grace said doctors give the baby a smaller dose of opiates to slowly wean them. All babies with known exposure are monitored for 72 to 96 hours in the special care nursery. If there are no signs of withdrawal, they then go home. But some must stay for weeks.
Babies are also swaddled. Lights are kept low. And volunteer “cuddlers” are on call.
Grace said there’s almost always at least one baby in the special care nursery for this issue.
“It’s quite common,” Grace said.
Strausbaugh said that in 2017, out of 1,247 babies born at Blanchard Valley Hospital, 78 tested positive for an illegal substance (a figure that includes other drugs, like marijuana, as well as opiates). Of the 78, 17 needed medication to wean them off the drug.
During the first quarter of 2018, of 259 babies born, 24 were prenatally exposed to an illegal substance and three of the 24 needed medication to treat it.
Bruno said babies born to mothers who are receiving medication and therapy in his program have not needed to stay in the special care nursery in the long term for treatment.
Bruno said what’s most rewarding for him is seeing women shift “from feeling hopelessness to having hope. Seeing them evolve into… confident mothers in waiting.”
Both Westcott and Bruno said there’s a high risk of relapse for the mothers after delivery. Challenges include hormones, stress, postpartum depression and anxiety, and logistical issues like keeping counseling appointments with a newborn. Bruno said motivation may wane once the baby is born, but the goal is to keep women engaged so they don’t relapse.
Women receive care at both the Women and Children’s Center and at A Renewed Mind, but a future goal is to have all the care at one location.
The MOMS grant is specifically to serve Hancock County mothers, but Bruno said treatment is available at A Renewed Mind to any pregnant woman from the region.
For more information, call the Women and Children’s Center at 419-424-0180 or A Renewed Mind at 419-422-7800.