Parkland program for pregnant women with addictions improves health of babies, mothers
Neonatal Abstinence Syndrome affects thousands of U.S. infants
Every expectant mother dreams of delivering a healthy baby – even moms addicted to alcohol or drugs. Molly, Tammy, Erika and Beverly all have long histories of using substances ranging from alcohol to cocaine and heroin. Recently, each voluntarily checked herself in to the antepartum unit at Parkland Memorial Hospital to undergo tapering before giving birth. Aided by services provided by Parkland’s Perinatal Intervention Program (PIP), they hope to finally get ‘clean’ and build a better life for themselves and their unborn infants.
“The day I heard about this, I came,” said Molly, 36. “It’s a blessing.” The mother of three teenage girls, she is expecting a boy. Over the past decade, she used heroin, meth and Xanax and tried to detox twice but failed. The reason, she says, is she wasn’t ready.
“I had excuses. Addicts always say, ‘I’m going to do it tomorrow,’ but that day never comes,” she said. “This time is different for me. I’ve been at Parkland for six weeks and there have been some rough days, but now it feels pretty good. I just wish I would have come sooner.”
“Virtually all mothers hate their disease of addiction and want to get clean and take care of their kids,” explained Kurt Kleinschmidt, MD, a toxicologist and board-certified addiction medicine specialist who serves as medical director of PIP and Professor of Emergency Medicine at UT Southwestern Medical Center. “The problem is they have a disease, addiction, that is harmful to both them and their babies. We give mothers the tools – medical and psycho-social – to battle their disease.”
Neonatal abstinence syndrome (NAS) is a group of problems that occur in a baby exposed to opioid (heroin, hydrocodone, oxycodone) drugs while in the mother’s womb. It can cause premature birth, poor intrauterine growth, seizures and other health problems. With the explosion of opioid drug use across the U.S., it’s becoming an all-too-common occurrence.
The costs of NAS – emotional, physical and financial – are extremely high for families, hospitals and society. A national study by Health Services Research found that infants exposed to illicit drugs stay approximately seven days longer in the hospital at a higher cost than a child who was not exposed. Also, lifetime costs of caring for a substance-exposed child have been estimated between $750,000 and $1.4 million by the Children’s Bureau (National Abandoned Infants Assistance Resource Center), while the Centers for Disease Control and Prevention (CDC) estimated that the lifetime cost of children with Fetal Alcohol Syndrome alone is $2 million.
While the Maternal Fetal Medicine service at Parkland has had the PIP program for years, the program has been recently augmented with increased use of screening for substance use and the addition of new staff through funding from the Network Access Improvement Program (NAIP). NAIP was created by the 83rd Texas Legislature to increase the availability, quality and effectiveness of primary care for Medicaid clients by providing incentive payments administered by managed care organizations to participating health institutions and public hospitals. The PIP program not only improves outcomes for mother and baby but also significantly reduces the costs of caring for the mother and baby during delivery and after.
A multidisciplinary program, PIP includes maternal fetal medicine physicians and nurse practitioners; neonatologists; nurses practicing at Parkland’s NICU, Maternal Fetal Medicine clinic, antepartum and postpartum units; Child Life Specialists; social workers; peer navigator counselors and others who see pregnant women with addiction issues at Parkland’s Maternal Fetal Medicine Clinic and as inpatients in the hospital before and after they deliver.
In 2016, Parkland expanded PIP by adding the services of Dr. Kleinschmidt on a part-time basis and in January 2017added a full-time substance use counselor, Daniel Melendez. More than 60 women have received treatment at Parkland through PIP since the beginning of 2017.
Some pregnant patients who want to be off opioids are admitted to Parkland prenatally for tapering treatment. These patients are typically sick with opioid withdrawal. Methadone is started to stop the withdrawal illness. Then, the methadone is slowly tapered off. The goal is to have the mothers off all opioid drugs at the time of delivery to prevent the occurrence of NAS.
In addition to medical treatment to wean off the opioid drugs, the women attend counseling and educational sessions five days a week during their stay. Their mornings include routine medical care with the Maternal Fetal Medicine staff. Three times weekly in the afternoons, Child Life educators provide training to all mothers on the unit in standard mothering skills. Women with substance use issues attend a group counseling session organized by counselor Melendez where they are encouraged to open up about their fears, hopes and struggles with drugs.
“Our goal is to break addictive behaviors. It’s an education process as much as a medical one. We connect patients with the help they need and encourage and support them on their journey to recovery,” Melendez said.
“All our interactions with patients are non-accusatory and matter-of-fact about their addiction,” said Melendez, who had substance use problems for 20 years and has been in recovery, “clean and sober,” for 21 years. “It’s a process of building trust. I tell them, ‘Honesty is step one. You have to be honest with yourself. You can’t work with problems unless you admit you have them.’”
During a recent group session with Melendez, there were moments of tears, laughter, somber silence and sharing.
Erika, 30, has used alcohol and heroin since she was 17. She is expecting her fourth child, a girl. “I’ve been scared. I sincerely want to put drugs and alcohol behind me. I’ve made many broken promises in the past but I have to prove myself now with my actions, not my words,” she said.
“The program does not stop at delivery,” Dr. Kleinschmidt said. “We are building it to follow our patients post-delivery to ensure our moms and babies have the best possible outcomes. Addiction is a disease for life, just like diabetes or other chronic conditions. So we help them understand they need a lifetime of support.”
“I’m done with it,” said Tammy, 30, who started using cocaine and heroin when she was 16 and expects to deliver her baby in late May. “I just want my family back. I’m ready. Before, I didn’t have any hope. But now, here it is, knocking at my door.”
For more information about Parkland, please visit www.parklandhospital.com.
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