She asked to not be identified. And it’s understandable given the stigma attached to addiction. For this story, we’ll call her “Mary.”
Mary lives in eastern Kentucky and has struggled with an addiction that began with painkillers and progressed to heroin.
“As soon as I opened my eyes, I had to get it,” Mary said. “And even when I did get it, then I had to think of the next way that I was going to get.”
Mary was using when she learned she was pregnant with her first child. She sought treatment but the disease had a tight grip on her.
The child was born dependent on opioids and went through the pains of withdrawal shortly after delivery.
“To see that little boy go through that stuff, you’d think that I would, like, change my life around immediately but I didn’t,” Mary said. “I didn’t want to believe it. I was in complete denial that because of my choices, it was my fault that he was going through that.”
Mary sought treatment but relapsed. Then she learned she was going to have a second child.
The number of babies born suffering from neonatal abstinence syndrome -- the medical term for being born dependent on a drug -- is on the rise.
A study published in the Journal of the American Medical Association-Pediatrics found “incidence rates for neonatal abstinence syndrome and maternal opioid use increased nearly 5-fold in the United States between 2000 and 2012,” and appears to be most pronounced in rural areas.
In the Ohio Valley the statistics are startling. Ohio and Kentucky both have rates well above the national average. In West Virginia the most recent data show that for every thousand live births there are fifty drug-affected newborns, the highest such rate in the nation.
Health care workers across the region are responding, finding new ways to treat both babies and mothers.
“Get Addicted to Motherhood"
Nationwide Children’s Hospital in Columbus treats babies transferred from other hospitals when the symptoms are at their most severe...excessive crying, unable to self-console, unable to eat appropriately, all the way up to seizure activity.
“Based on each symptom and the severity of it, that baby is assessed a number,” Neonatal Intensive Care Unit’s Administrative Clinical Leader Amy Thomas said. “If that number reaches a certain level, then that tells us we have to treat that baby.”
The staff has been developing the treatment plan since 2013. This was around the time when staff noticed a correlation between increasing length of stay and drug-affected babies.
Treatment begins with non-pharmacological methods like cuddling and music therapy.
But if the withdrawal cannot be managed, morphine is administered. As the baby shows signs of improvement, the dosage is decreased until they are no longer dependent.
Educating the parents on how to care for the baby through methods like skin-to-skin comforting and breastfeeding is also important. And Thomas said treating mothers and fathers as parents, rather than as addicts, can have an impact on the baby’s life.
“I have that window of opportunity there to get her to fall in love with her baby, get her addicted to motherhood,” Thomas said.
The hospital has seen its admission numbers for drug-affected babies go down as birth hospitals have improved their ability to provide care.
Improved quality of care has also decreased the length of stay for the young patients, which can also help cut costs. The Ohio Mental Health and Addiction Services found in a 2014 study that each drug-dependent newborn can cost the healthcare system $56,000 or more, and most of the patients were on Medicaid.
Lily’s Place in West Virginia
A unique facility in Huntington, West Virginia, aims to reduce the burden on hospitals.
At Lily’s Place, babies are cared for in individual nurseries where the lights are low and noise is kept to a minimum.
“These babies are born very easily overstimulated,” said Rhonda Edmunds, the director of nursing. “We feel a quieter, more homelike environment is the environment that they need.”
A staff of registered nurses provides another option of care for drug-affected babies outside of hospitals.
The facility is one of only two of its kind currently operating in the U.S. and it wasn’t easy to get started.
“The state allowed us to be part of a pilot program but all the babies had to be in state custody for that, which was a hinderance to getting babies over here,” Edmunds said. “But we don’t have to do that anymore.”
Since it opened in 2014, Lily’s place has been working to help other facilities get started and get through the red tape.
The group published a book in 2015 on how to start a neonatal withdrawal clinic and is updating it to reflect changes in federal regulations that came with the passage of the Comprehensive Addiction Recovery Act last year.
M.O.M.S. in Ohio
Treatment for pregnant women, meanwhile, can be difficult to come by in the Ohio Valley. The ReSource analyzed data from the Substance Abuse and Mental Health Services Administration on treatment centers across all three states and found only a quarter of those centers accepts pregnant women.
A group of organizations in Athens County, Ohio, took a collaborative approach in addressing this issue.
Several years ago the OB-GYN at OhioHealth O’Bleness Athens Medical Associates noticed an increase in the number of pregnant women coming in with addiction issues.
“I could see there was some burnout in my providers because these patients had so many other issues, social issues that we didn’t even know how to address,” Practice Manager Pam Born said.
So she reached out to the nearby Health Recovery Services organization in hopes of getting these mothers treatment.
The collaboration was so successful, they looked for other resources.
“As we identified a new problem, we would identify who in the community could meet that problem,” Born said.
Soon they were offering housing, childcare, and other services for the whole family.
Interest from lawmakers led to the creation of the Maternal Opiate Medical Support (M.O.M.S.) project. Athens County and three other areas are provided funding to assist the programs in the hopes that others would follow.
Born said collaborations can form in any community and take many forms depending on a community’s unique needs.
In Athens County, Born would like to work toward offering residential treatment for pregnant women and mothers in their program, which is difficult to find throughout the region.
Karen’s Place in Kentucky
Karen’s Place Maternity Center is filling this role for residential treatment in Louisa, Kentucky.
Addiction Recovery Care --with treatment centers throughout mostly rural Kentucky-- operates the new facility offering a balance of medical treatment, counseling, and a faith-based element.
“There are no centers doing what we’re doing in this part of Central Appalachia,” CEO Tim Robinson said. “And we felt we had the infrastructure and resources to do it.”
The 16-bed facility at Karen’s Place is a refurbished home in a secluded area, with 24/7 staff support and amenities for both mother and baby.
By focusing on the moms, Robinson said they are investing in the family as a whole.
“We’re not going to have true compassion for the babies until we have true compassion for the moms,” he said.
Karen’s Place in Louisa is where I met “Mary,” the mother of two whose first child was born drug-dependent. Mary is now in recovery. She was the first woman to come live at Karen’s Place before it was opened to the public in late January.
She sought treatment again after the birth of her first child and was able to get clean for a while. However, she relapsed around the time she found out she was pregnant again.
Mary was determined to give this baby a healthy start. She reached sobriety in October and her second child was born about a month ago with no signs of being affected by opioids.
“It’s been amazing,” she said. “He’s healthy, happy. He’s a calm little guy.”
Living at the maternity center has allowed Mary to focus on her continued recovery, motherhood and her faith. She aspires to further her education and someday help other mothers suffering with addiction.
“I’ve always encouraged people, if they’re still breathing, there’s still hope,” she said.