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Despite Barriers, Addicted Moms-To-Be Are Finding Help

There are many different aspects to the drug problem in Vermont, but perhaps none is more challenging – and emotional – than the issue of addiction and pregnant women.

Even though the majority of substance-dependent women seek help when they become pregnant, both the illicit drugs and those used for treatment can cause withdrawal symptoms in newborns.

Last August, Leslie Thorsen wrote a letter to Governor Peter Shumlin, prompted by her experience as an operating room nurse at Springfield Hospital. Thorsen says what troubles her most about Vermont’s drug abuse problem is the number of babies born with withdrawal symptoms – known as neonatal abstinence syndrome (NAS) – because their mothers had used opioids.

“This past summer I got called in three times in a row for a C-section that the babies were opiate addicted,” says Thorsen.

According to state figures, the number of babies with neonatal abstinence syndrome has increased from .26 percent in 2002 to 2.6 percent in 2010*. 

"I was terrified to continue using, but I was terrified to tell my doctors that I needed help because I thought they would take my baby from me immediately."

In 2010, 162 NAS infants were born in Vermont hospitals and to Vermont mothers at Dartmouth-Hitchcock Medical Center in New Hampshire. As the number of mothers suffering from addiction has increased, it’s become clear that putting them at the end of a treatment waiting list is dangerous for them and their babies.

It also takes a village of care providers: doctors, counselors, social workers, nurses and others working together for a pregnant opiate user to get treatment, and stay clean through her pregnancy and beyond.

Victoria – she asked that her last name not be used – was using heroin when she became pregnant 11 years ago. At that time a new program to treat expecting women using opioids was just underway at Fletcher Allen Health Care.

She was unaware of it, though, and to her the only choices she had were bad ones.

“I knew a girl who was six months pregnant and had tried to detox herself. She immediately went into labor, gave birth to the baby and the baby died,” she says. “So I was terrified to keep using and I was terrified to stop using.”

A friend directed Victoria to Fletcher Allen, where she received counseling and treatment. The treatment involves stabilizing the mother with the maintenance drugs methadone or buprenorphine. Going cold turkey is dangerous for the developing child.

The treatment involves stabilizing the mother with the maintenance drugs methadone or buprenorphine. Going cold turkey is dangerous for the developing child.

Victoria was fortunate.  At the time she sought help, providers say many pregnant women simply stayed in the shadows, at the peril of their health and that of their babies.

Even as treatment and services became available, women were reluctant to step forward. 

“Women were very scared about coming in to treatment,” says Dr. Marjorie Meyer, an obstetrician at Fletcher Allen. “They thought it immediately meant we were going to take their existing children from their home; that we were going to take their current pregnancy, take their baby away. There was a huge amount of fear.”

That’s what Victoria feared.

“I was terrified to continue using but I was terrified to tell my doctors that I needed help because I thought they would take my baby from me immediately,” she says.

In some states, using opioids during pregnancy is considered child abuse. But Karen Shea, with the state Department of Children and Families, says Vermont takes a different approach.

“The idea behind that is we don’t want any barriers to a parent seeking treatment. I don’t want them to be in the shadows,” says Shea.

"The idea [is that] we don't want any barriers to a parent seeking treatment. I don't want them to be in the shadows.” Karen Shea, Vermont Department of Children and Families

Care providers are required to report to the state when a pregnant mother is using illicit drugs, but Shea says in cases where a woman refuses treatment the department can go to court and ask that a child be removed to foster care.

The preference is to explore options – like having other family members help with care. 

Springfield hospital nurse Leslie Thorsen says the state is not doing enough to protect the babies born to mothers who are not in treatment.

“I firmly believe that if the mother comes in and there's an opiate in their system and the baby's got that in their system, the baby should not be going home with that mother,” Thorsen says.

Care providers say the majority of mothers-to-be who need treatment get it at some point in their pregnancy. But state data indicates 1 in 5 babies born with neonatal abstinence syndrome was born to a mother who was not in treatment, known as medication assisted therapy. In 2010 the number of NAS babies born to mothers who were not in treatment was 32.

There are a number of barriers for those who do seek treatment. In some cases there are distance and transportation issues.  There’s also a psychological and emotional bridge that is too far for some.

“Some women do seek treatment early,” says Linda Hurley, who manages the childbirth center at Springfield Hospital. “Some choose no because they feel guilty and they don’t want to present themselves. We spend a lot of time talking women who haven’t had any prenatal care into coming.”

Even though the majority of substance-dependent women seek help when they become pregnant, both the illicit drugs and those used for treatment can cause withdrawal symptoms in newborns.

How many pregnant women are using illicit drugs, or in treatment for addiction?  There are no statewide numbers available, but Hurley says 20 percent of the babies delivered at Springfield Hospital are born to women who have tested positive for opioids.

*A portion of the increase may reflect an improvement in data collection.

The figures do not reflect all mothers who may have used opioids during their pregnancy because not all infants born to mothers who have been using opioids exhibit symptoms of neonatal abstinence syndrome. 

Some infants may also test positive for NAS due to treatments unrelated to the misuse of opioids.

This story is the first in a three-part series examining what's being done to care for pregnant Vermont women with addiction. Listen to Part 2 and Part 3.

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