As the rate of opioid addiction continues to rise in the Minnesota, it only makes sense that the number of addicted pregnant women will also rise. To be addicted and pregnant is a toxic situation: Expectant mothers feel guilt, shame and anxiety about the fate of their future children, but when they reach out for help, they often run into a dead end. Most addiction treatment programs do not accept pregnant women.
The Drug and Alcohol Rehabilitation Services Program at St. Joseph’s Hospital in St. Paul is the only inpatient program in the state that accepts pregnant women. Earlier this year, as staff began to notice that enrollment of expectant mothers was on the rise, they decided to create Best Start for Moms and Babies, a comprehensive drug and alcohol rehabilitation program designed specifically to meet the needs of this vulnerable population. To meet patients’ unique needs, they teamed with midwives, behavioral health providers and addiction medicine physicians to create a holistic program designed to give patients and their future children higher odds at success.
I wanted to hear more about Best Start for Moms and Babies, so I spoke with Kathryn Manning, M.D., St. Joseph’s senior medical director of mental health and addiction care. She told me that the numbers of addicted pregnant women is on the rise, and she thinks those numbers will continue to increase over the next few years.
With Best Start’s close attention to the specific needs of pregnant women facing addiction, Manning said that her staff hopes to change the course for these women’s futures: “With education and compassion,” she said, “we want to help them truly understand the source of addictions and find a way to move beyond them.”
MinnPost: How unusual is it for a chemical dependency program to treat pregnant women?
Kathryn Manning: St. Joseph’s outpatient chemical dependency program has a long history of working with pregnant women. But our program is unusual: We are the only inpatient treatment program in Minnesota that takes pregnant women. It has always been a challenge for women who are pregnant to get addiction treatment, and we want to be there to provide that help.
MP: But don’t pregnant women desparately need addiction treatment? Why are there so few programs that accept them?
KM: OB care is a risky area of practice to begin with. And a woman who has been using substances during her pregnancy is automatically considered a high-risk. High-risk pregnancies can be expensive and dangerous. To take on the liability of this kind of patient is something that many programs struggle with.
MP: If that’s the case, why does St. Joseph’s continue to provide inpatient care for addicted pregnant women?
KM: I think it’s more of a mission for us. Providing care for women who are struggling with these issues fits with the kind of work we want to do. Supporting Best Start for Moms and Babies is an acknowledgement of the fact that we’ve chosen as an institution to take this on. We see that we’ve made such a difference in so many women’s lives, and we want to continue that.
MP: Being pregnant and addicted must feel overwhelming. I’m guessing the women you treat feel scared and guilty — and maybe wary of being judged.
KM: There is a lot of blame and shame in these cases. Some of the women we see even have a hard time finding an OBGYN willing to care for them during their pregnancy. To be facing this kind of challenge and not having an OB willing to take you on is a daunting reality. Because that, we feel like this program is even more important. We’d been providing care like this for years, but when things changed at the hospital, we knew we wanted to be able to continue to do what we’d been doing — and even enhance the care we provided. We felt that it was so important to the women’s well-being and the long-term well-being of their children.
MP: Tell me more about how things changed at St. Joseph’s.
KM: Last summer, the hospital’s labor and delivery unit closed. It was adjacent to our inpatient chemical dependency unit, where the women we’re talking about were among the patients being treated. When we were informed that the OB unit was going to close, we knew a lot of things had to happen if we wanted to continue to take care of this vulnerable population of people who really need our services.
MP: What did you do?
KM: At first, there was talk about whether or not we could even continue to work with pregnant women, but there was clearly a strong desire to continue. Then the HealthEast midwives group stepped in, offering to work with us to create a program that could serve the care needs of this special group.
MP: Why was it important to have a staff of midwives on call?
KM: A pregnant woman with an active addiction is considered a high-risk pregnancy, so having the midwives close by and ready to respond if a patient needed their help was comforting to the other medical providers who are providing care to these women when they are enrolled in our program. The women we serve come into the program at any point in their pregnancies. They need to have close medical monitoring in case they go into labor. Some women are in their third trimester, and also sometimes babies are born early, especially since babies of addicted mothers are at higher risk of premature birth. So we need to have careful monitoring to make the program work.
MP: Traditionally, midwives work to establish strong relationships with a mother, and to follow her after the birth of her child. Do the midwives who work with Best Start for Moms and Babies take the same approach?
KM: The nice thing about this group of midwives is they are very dedicated to establishing a care relationship with the women in our program. They are also committed to continuing to care for them after their babies are born.
MP: How do they do that?
KM: From the start, we work to establish a long-term relationship between the midwives and the women in the program. Even before their first meeting, the midwife will gather any medical information on the patient. This will help us make a decision about whether the patient is appropriate for our program. Then the midwife will work to establish a strong patient-provider relationship, explaining that she is here to help the mother through the pregnancy, birth and post-partum process.
MP: What is your role at Best Start for Moms and Babies?
KM: I am a psychiatrist on St. Joseph’s chemical dependency unit. I provide psychiatric counseling and ongoing care for all patients. I meet with patients and assess their mental health needs while they are on the unit. I care for our pregnant patients in the same manner.
MP: Is your program successful at helping participants reduce or end drug use during their pregnancies?
KM: I would say by the time that they’ve gotten to this unit women are more likely to acknowledge their situation, and show a determination to work to make things right for themselves and their child. That said, a lot of people ask about the success rate of treatment programs. Most treatment programs don’t actually keep data on success rates. It has to do with how you measure success: A month of sobriety? A year of sobriety? One relapse? Two? We’re here to help people in their walk of recovery, so that is a hard question to answer.
MP: I imagine that a lot of the women in your program are there because they are focused on doing everything they can to maintain custody of their children.
KM: Most pregnant women living with addition are worried and nervous about the future of their relationship with their baby. They’re often worried about the future of their relationship with their larger family as well. As they work on their addiction, these women begin to realize that the future isn’t just about them. It is about them and their unborn child. Most of these women are worried about losing custody of their babies.
MP: Has your program been able to help women wean themselves off opioid-based medications during their pregnancies?
KM: Yes, but it can be hard. I can think of cases where women were so addicted when they came to us that they felt like they could not stop using even though they were pregnant. One woman we treated had continued to use heroin at lower amounts during the earlier months of her pregnancy. She was referred to us by her OBGYN. She told us she felt that she could not safely stop using on her own, but she came to our program voluntarily and successfully transitioned off heroin. To do this, she used Suboxone, and she was successful. Being in an inpatient treatment program made all the difference: It would have been very difficult for her to do what she did on her own or in an outpatient program.
MP: Drugs like Suboxone are important, but as a psychiatrist, are you also able to help women in your program use psychiatric medications to help them reduce their use of addictive substances?
KM: I help patients by prescribing medications that will help them with their addiction and are safe to use during pregnancy, including psychiatric medications like antidepressants.
MP: Abruptly quitting addictive substances can be dangerous to a pregnant mother and her fetus. How do you help the women in your program safely reduce their drug use?
KM: In a number of ways. We recently worked with a woman who was addicted to benzodiazepines. Her OBGYN referred her to our inpatient program. At the time of admission, the patient wasn’t convinced that these medications were something she should stop, but the positive ending of this story is that during her time on our unit, we were able to help her see that this was a medication that she needed to stop. We were able to wean her off the benzos. We know that stopping these kinds of medications abruptly puts a person at risk for seizures, so it has to be done under direct medical care. This woman left our program very happy to be off benzodiazepines. Our desire and hope is that once she delivers her baby she will be able to connect with a mental health provider to get her anxiety managed without the use of an addictive substance.