For Expecting Moms With Opioid Addiction, Health Starts With Compassion

On Tuesday, Brittany* makes a familiar trip to the University Hospitals Rainbow Center for Women and Children. She’s been going to a special clinic for mothers with opioid addiction called UH MOMS (Maternal Opiate Medical Support) 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.

Stigma and Fear

Unfortunately, addiction treatment for pregnant women can be hard to obtain. Some providers consider pregnant women to be too high-risk, and there is a great deal of misinformation about what 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 the UH MOMS clinic in the 34^th week of her pregnancy.

The statistics about opioid addiction during pregnancy are grim: a five-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 were at risk of being born premature, growing too small, or having neonatal withdrawal symptoms. Most strikingly, women were dying: between 2007 and 2016, the percent of maternal deaths caused by opioid misuse more than doubled from 4 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.

At the UH MOMS clinic, we approach addiction as a chronic disease, not as a moral failing. Our team is guided by the philosophy 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 is turned away for care, and all mothers are treated with respect.

The care at UH MOMS is patient-centered, comprehensive, and conveniently located in one space. Moms see the same team members over and over again, and can receive prenatal care and addiction treatment in the same appointment.  Additionally, women have access to social workers, mental health specialists, maternal fetal medicine specialists, pediatricians, dentists, legal aid volunteers, and insurance specialists. If a woman has needs that cannot be met on site, she is referred to community resources through the unique Rainbow Connects care coordination program. The Center also houses prenatal ultrasound, a pharmacy, and laboratory services. As women approach their delivery date, we make sure they have time to discuss birth plans, breastfeeding, pain management, and birth control. All women are given the opportunity to meet with the pediatric specialists who care for babies with opioid withdrawal, and to arrange tours of the hospital. Postpartum, mothers may continue to see the UH MOMS team for up to one year, as this is a particularly high risk time period for depression and substance misuse.

After meeting with the UH MOMS team, Brittany got started on medication assisted treatment with buprenorphine (Subutex®), the preferred treatment for pregnant women addicted to opioids. She was also finally treated for the depression that escalated her opioid addiction. If she ran into obstacles, the UH MOMS team helped her troubleshoot. A month later, she delivered a health full-term boy, heroin-free.

Troubleshooting Obstacles

UH MOMS works closely with the nationally recognized pediatricians and neonatologists at UH Rainbow to provide babies with the best possible start in life. At delivery, mothers are encouraged to participate in delayed cord clamping, skin-to-skin, and other non-medication treatments known to improve the health of the baby. After delivery, mothers are able to soothe their babies in the calming environment of their own private rooms. For babies who experience withdrawal, the expert neonatologists at UH Rainbow employ groundbreaking protocols to reduce the length of time the baby needs to stay in the hospital.

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 towards better.

If you or someone you know is suffering from opioid addiction while pregnant, let them know that they deserve great care, and that help exists for them. UH MOMS accepts patients from all over Northeast Ohio and takes most insurance plans, including Medicaid. We provide total care, as well as collaborative care for women who want to continue to see their original OB/GYNs or addiction care providers. The clinic is every Tuesday afternoon at the Rainbow Center for Women and Children at 5805 Euclid Avenue, Cleveland, OH. To get started on your journey, call (216) 675-6653 and ask to be scheduled with Dr. Lulu Zhao in the UH MOMS Clinic. We’re looking forward to meeting you.

*Names have been modified in this article to protect the privacy of individuals described.

Lulu Xu Zhao, MD, is a obstetrics/gynecologist at University Hospitals.