Many Hoosiers struggle with addiction, and mothers are no exception.
Estimates show about 5 percent of pregnant women abuse one or more substances, according to The National Institute on Drug Abuse. This could cause complications in pregnancy and later in a child’s life. For mothers, it could be deadly. In Indiana, overdose is the top cause of death in pregnant women and new mothers.
Dr. Sarah Gopman, medical director for the Circle of Recovery for Families at Eskenazi Health, works with expecting mothers dealing with substance use disorder, particularly opioids. While these situations can be risky, Gopman said it’s possible to have a healthy pregnancy and a normal delivery.
“They can have a healthy newborn and a health child going forward with the proper support,” Gopman said. “Prenatal care really makes a huge difference, and engaging with trusted providers really makes a huge difference.”
Gopman said getting patients on medication is usually the safest thing for their pregnancy. This medication-assisted treatment helps people quit or decrease using opioids, and they help with withdrawal symptoms.
Withdrawal symptoms feel like a bad flu, Gopman said. It can be uncomfortable and painful. Sometimes patients are afraid to make the transition to medication, Gopman said.
“I think the thing that people often feel once they're on medication is they can't believe how uncomfortable they were when they were using the substance,” Gopman said. “People feel so relieved to be on medication. So, I want that opportunity for everybody.”
Patients with high-risk pregnancies should have more appointments and sometimes need special care after delivery, according to the American College of Obstetricians & Gynecologists.
Gopman said she sees patients every two weeks, and then once a week toward the end of the pregnancy. These appointments monitor the medication and the baby’s development.
Gopman wants to see patients frequently, even after birth.
“Our plan would be, one, I want to see them back really quickly after delivery, because I want to keep them engaged in care, make any medication adjustments that we need to,” Gopman said. “Also, I'm going to use some of those appointments for newborn checkups too.”
Women that use substances such as drugs, alcohol or tobacco have higher risks for stillbirths, according to the The National Institute on Drug Abuse. Other outcomes include a premature birth or a low birth weight.
For mothers using addictive drugs, their newborn could be born with withdrawal symptoms. Gopman said doctors typically watch newborns for five days.
“If that medication is necessary, we would maintain it until the symptoms are controlled, wean it down, and then watch babies, usually for about48 hours after the last dose, and then they'd be ready to go home,” Gopman said. “A lot of what we're doing is education during that time. Most kids don't need medication to treat withdrawal symptoms. They just need a calm environment. They need to breastfeed.”
She added, “You'll hear people say, ‘The mother is the medicine’”
There’s a lot of evidence that shows keeping children with their biological family and putting in proper support provides the best outcomes, Gopman said.
Her program, the Circle of Recovery for Families, focuses on long-term support. Because substance use disorder is a chronic condition and relapsing is common, Gopman said there’s no end-point for care.
“We think the ongoing relationship increases the likelihood that they'll engage in care, and that when they have a rough spot, they'll let us know," Gopman said. “We can put additional supports in place."
Long-term developmental effects of substance use during pregnancy depend on many factors, Gopman said. It’s possible a child could have a higher risk of behavioral disorders and some learning disorders, she said.
In addition to addiction, a lack of housing, food insecurity or an incarcerated family member are other risk factors.
“It's very difficult to sort out all those different risks, and many of the risks come together,” Gopman said. “The most important take home message is that all children, regardless of what we are aware of in terms of their in utero exposures and early childhood exposures, should have regular evaluations for their developmental milestones.”
