Doula Heidi Akpatee holding a 1-month-old baby boy. Akpatee supported his mother, who is a methadone user, through two pregnancies and births.
Ashley loves her three children. She works hard to be a good mother, but because she is a methadone user, when she goes to the doctor or deals with other medical professionals, she’s hyperaware of being judged.
Take the midwife Ashley saw some months ago, before her youngest son was born in December.
“I felt judged by her and I didn’t like that,” said Ashley, who was addicted to opioid-based pain medication and briefly used heroin but now controls her addictions with methadone. (Ashley asked that we not use her last name in this article.) “The midwife didn’t know anything about what was going on with me. She didn’t know who I am or any of the good things I’m doing with my life. She just knew I was on methadone, and she seemed like she was against me because of that.”
It’s understandable that a medical professional might look askance at a pregnant woman struggling with opiate addiction. The highly addictive drug is toxic — not only to the mother, but also the fetus. Mothers who use opiates while pregnant face an increased risk of miscarriage and stillbirth. A large percentage of babies born to addicted mothers suffer physical and intellectual disabilities and dangerously low birthweight. Many are born addicted and experience painful neonatal abstinence syndrome (NAS), or withdrawal, during their first days and weeks of life.
Methadone, while an imperfect solution (some percentage of babies born to mothers on the drug still experience NAS), carries fewer risks for both baby and mother. But methadone-using mothers like Ashley often face discrimination when they interact with health-care workers. This means that many avoid getting the care that they and their babies need. And when it comes time to give birth, these moms sometimes report feeling frightened and powerless, leading to worse outcomes for both mother and child.
A unique partnership between Specialized Treatment Services (STS), a Twin Cities-based methadone clinic, and Everyday Miracles, a Minneapolis nonprofit dedicated to reducing health-care disparities for low-income mothers, aims to address this issue by supporting addicted mothers like Ashley through their pregnancies and births. Mothers who get the nonjudgmental support they need are less likely to use drugs and more likely to take care of themselves and their unborn children, resulting in better outcomes for all.
Everyday Miracles’ staff of doulas, or specially trained birth assistants and advocates, is a key element in this partnership. Doulas step in and help addicted mothers navigate the medical system, and guide them and their babies to the births they desire.
“Whether it was at the doctor’s office or the hospital or seeing any type of care provider, our moms would come back with stories of how the second the provider found out they were on methadone they were treated poorly,” said Melissa Prudhomme, program director at STS’ location on Minneapolis’ Central Avenue. “They were dismissed, treated like they didn’t know what they were talking about or were just ‘less than.’ There is a lot of stigma around heroin use and methadone. And when a woman is pregnant at the same time, we were seeing a lot of people not being so nice to them.”
Teaming with Everyday Miracles and adding doulas to the birth team helped get STS’ addicted moms heard, Prudhomme said: “This partnership gives them a voice, and that’s what they need.”
MinnPost photo by Andy Steiner
Casts of pregnant bellies decorate the walls of the
Minneapolis office of Everyday Miracles, a support program
for low-income women.
Everyday Miracles is focused on helping women who usually feel uneasy in their interactions with the medical system feel more confident and supported, said Melissa Gutierrez Nelson, Everyday Miracles' marketing and program coordinator. The program’s clients are all low-income women on Medicaid. Many are women of color who are single mothers.
“A lot of our moms say that they feel intimidated by hospital and clinic staff,” Nelson said. “This is the world we live in. Because she carries a feeling of authority and expertise, a doula is going to change the care that the client might get in a hospital or a clinic.”
That’s especially the case for moms on methadone, said doula Heidi Akpaette, who attended two of Ashley’s three births.
“What I discovered as a doula for moms on methadone is the importance of the long-term relationship, of building that trust and being the one that is safe and supportive,” Akpaette said. “At the hospital, these moms feel condemned and zeroed out when staff finds out they are on methadone. It’s my job to support them while they are going through their births so they can have the same experience as anybody else.”
Because Ashley had already established a strong relationship with Akpaette, she decided to let her know about her experience with the midwife.
“I told Heidi that my appointment with the midwife felt really awkward once she knew I was on methadone,” Ashley said. “So Heidi went with me to my next appointment. Everything worked better when she was there.”
Akpaette said that she’s happy to be able to help ease the pregnancy and birth experience for her clients. She thinks it’s all about relationship building: She establishes trust with clients like Ashley, and garners respect from medical professionals.
“I get to be the bridge between the mother and the health-care team,” Akpaette said. “I think that’s important for anybody, but I think it’s really important when you’re in a situation when you are a little more vulnerable — especially when you are in a situation where people are a little more predisposed to judge you without knowing you.”
Located in a large, sunny suite in the Waterbury Building in Northeast Minneapolis, Everyday Miracles offers cozy couches, a kitchen, a donation closet full of free baby supplies, a treatment room for a chiropractor, and a space for prenatal yoga classes. Large, colorfully adorned casts of pregnant bellies decorate the wall.
When the partnership with STS was launched, all Everyday Miracles doulas were given the option to work with methadone-using moms. Interested doulas, independent contractors whose fees are paid through Medicare, were trained in the basics of addiction medicine and drug counseling by STS staff. Akpaette signed up.
“It’s been nice for doulas to have the option of working the methadone counselors to provide holistic care,” she said. “We’re not really trained in drug counseling, but we can get insights from STS staff and we can be the liaison for the hospital and health-care portion of the pregnancy.”
Akpaette said that the number of moms on methadone that she has worked with so far has been, “minimal, to be honest. I haven’t had tons and tons of clients in this situation, but enough to walk that journey.”
The journey Akpaette refers to is risky, Nelson said. Pregnant women on methadone are carefully monitored, with regular drug tests to confirm that they are staying sober. Women who keep abusing drugs during their pregnancies are at high risk of losing their children to child protection.
“There are a lot of unknowns about what is going to happen with methadone and pregnancy,” Akpaette said. “They don’t know if the baby will end up in the NICU. They don’t know who is going to be at their birth and why. I want to help a mom in that situation be empowered to ask important questions so they can go into their birth having a clear understanding of how it is going to be different because of the methadone. Knowing that helps them feel more empowered."
Though she does lean on Akkpatee for support, Ashley is usually quite self-assured and confident, Nelson said.
“When she feels comfortable, Ashley is pretty well spoken and direct. Other clients, even with the presence of a doula, wouldn’t feel comfortable speaking out for themselves, but Ashley usually does.”
In Everyday Miracles, Ashley has found a place where she feels comfortable, a place that is consistent, warm and welcoming. When she brings her youngest child in for a visit, staffers coo and beam. Akpaette scoops up the infant and cuddles him, while he stares at her with calm, unblinking eyes.
“What I love about Ashley is she’s just a great example of the way Everyday Miracles works to create community,” Nelson said. “Heidi’s connection to her has kept her connected to us. These days, she’s a client who just pops in to say hello, who brings her baby. When she’s here, she does the dishes just to help out. She just is a lovely soul and we love her. I feel like this community is an extension of the support that Heidi’s been able to give her.”
Ashley needs all the support she can get: Addiction runs in her family. “I got an auntie that passed away because of it,” she said. “My mom had just been on the clinic. That’s how I started there.” She said her own addiction started with pain medication prescribed after her older brother died in a car accident. “It was really bad,” Ashley said, tearing up. “That’s how I started. It was just all bad.”
Ashley said she knows it will be tough, but for the sake of her children, she is committed to staying off opioids for good. With the support of Everyday Miracles and STS, she thinks she has a good shot.
“The program director at STS was my counselor at the beginning,” she said. “I’ve known her for almost four years now. I told her if I ever feel like I would want to use again, I would go to them first for the support. I don’t feel like I need to use right now. If I did, I would just go to talk to her and she would talk me out of it. That ain’t what I want to do. I just keep myself around people who are more supportive and happy. That way I’ll stay clean.”
Prudhomme feels cautiously optimistic about the future for Ashley — and her children. With a strong support network like the one that exists at Everyday Miracles, she may be able to find a life beyond addiction that she can build for herself.
“The women we send over to Everyday Miracles come back smiling, confident and feeling good about themselves,” Prudhomme said. “Nobody wants to say, ‘I’m pregnant and I have drug addiction.’ There is a lot of shame. We might have someone who doesn’t smile, who just appears to be very shy and rough around the edges. They go into Everyday Miracles, and they get nonjudgmental support from a group of women who just care about mom and baby. They come back a whole different person, one that can see a different life for themselves and their baby. It is pretty amazing to see.”