Pregnant women continue to receive support to combat their substance abuse problems through the Drug Free Moms and Babies Program (DFMB) that operates in coordination with the OB/GYN department at Greenbrier Physicians, LLC, and also collaborates closely with the OB department at Greenbrier Valley Medical Center (GVMC).
The primary goal is to support healthier outcomes for both mom and baby by providing prevention, early intervention, education, addiction treatment, and recovery support services. It is supported through funding from West Virginia Department of Health and Human Resources, Division of Behavioral Health and Health Facilities, the WV Office of Maternal, Child and Family Health, and the Claude Worthington Benedum Foundation, as well as an increasing number of local organizations and churches.
The impact of the West Virginia opioid epidemic is felt throughout the state. Families and communities are devastated by the effects. Service providers and residents are acutely aware of the need for substance abuse prevention, treatment, and recovery services. Substance use in pregnancy (including the use of tobacco, alcohol, marijuana, prescription, and illicit (illegal or non-prescribed drugs) have long been identified by West Virginia healthcare professionals as a major factor contributing to poor health outcomes for mothers and babies. Key informant surveys conducted by the West Virginia Perinatal Partnership have consistently shown that substance use in pregnancy is a significant problem identified by obstetric and pediatric providers as a driver of poor birth outcomes for both women and their babies.
Our region is fortunate to have been the site of a ground-breaking model of care for pregnant women with substance use disorders. The first of its kind in the state and now in its seventh year, Drug Free Moms and Babies was one of four original pilot sites which received funding starting in 2011 to develop integrated and comprehensive care models for pregnant women with addiction. It has been so successful in its efforts that it now serves as a best practice model of care for 11 additional DFMB programs around the state.
Dr. Coy A. Flowers, OB/GYN at Greenbrier Physicians and Medical Director of the DFMB, has been involved with the program since its inception. “In 2009, we identified that 19 percent of the 564 babies born here in the Greenbrier Valley had one or more drugs in their system,” he described, “But over the last six years, we’ve been able to reduce that number to 5 percent of 437 deliveries in 2018 testing positive for illicit use, and that’s incredible!”
Housed in the Greenbrier Physicians OBGYN clinic, DFMB works closely with the Obstetrics and Newborn Nursery department at Greenbrier Valley Medical Center (GVMC). Tameran Asbury, program coordinator/care manager, began seeing incoming obstetric patients at Greenbrier Physicians site in 2012. A master’s level clinician, licensed social worker, and substance abuse professional, Asbury meets with mothers, at their first prenatal visit, to complete a thorough clinical intake. This includes screening for current/past substance abuse, as well as other psychosocial issues.
DFMB mother Alisha states, “The program is very important and ultimately helped get me one step closer to where I needed to be. Without Tameran or her guidance, I may not have the life I have today, so to say I am thankful for her and the program is an understatement.”
All obstetrics patients are screened, through the use of a urine drug screen, at their first prenatal appointments and then randomly screened throughout pregnancy and post-partum. If positive for substance abuse, the mother is offered a variety of supports and services to assist her in reducing and/or eliminating illicit drugs before her baby is born. Women are referred to inpatient facilities if a higher level of treatment is needed.
Medication-Assisted Treatment (MAT) is currently the standard of care for those with an opioid use disorder. This includes pregnant mothers. Buprenorphine and Methodone are the most common treatment methods. MAT is the safest, most effective treatment for women and their infants. It still carries the risk for the infant to develop Neonatal Abstinence Syndrome (NAS). NAS is intrauterine exposure with clinical symptoms of physical withdrawal, from opioids primarily. “It is important to understand that NAS is treatable and that infants are not born addicted, states Tameran Asbury, program coordinator. The accurate terminology for these babies is that they are born dependent or in withdrawal.
Mothers who are stable in treatment are encouraged to breast-feed their infants. Breast-feeding offers benefits such as decreased severity of NAS, shorter hospital stay, and less need for baby to receive medication to treat their withdrawal symptoms. “Many think that it must be that the infant is getting some of mom’s medication through her milk, when, in actuality, very little of the treatment medications go into mom’s breast milk and therefore into baby. It is much more about the act of breast-feeding, lots of holding and close contact between mother and infant, that calms symptoms of withdrawal,” says Molly McMillion RN, BSN, IBCLC, LCCE a lactation consultant who works closely with the Greenbrier Valley program and is the Director of the state’s breastfeeding coalition, the WV Breastfeeding Alliance.
DFMB educates mothers during pregnancy about possible withdrawal symptoms, how to handle them and what to expect in general. The program is extremely holistic in that it connects mothers with other supports, services, and resources in the community to help them meet their needs and the needs of their family and live sober successfully. Through funding from the West Virginia Department of Health and Human Resources, Bureau for Behavioral Health and Health Facilities, the program recently hired Kelsey Carter, Peer Recovery Coach. A Peer Recovery Coach brings the lived experience to recovery and focuses on providing the individual with tools, resources, and supports to help achieve long-term recovery.
Pregnancy is a unique time. For women with substance use disorders, pregnancy is perhaps one of the only times she receives ongoing medical care. The increased motivation for improved health that often comes with pregnancy makes the prenatal and postpartum periods ideal for addressing substance use. DFMB helps mom, baby, and the whole family have a better, safer, and overall healthier lifestyle. Working together, the medical team, behavioral health providers, community supports/resources, and substance use treatment providers can have a significant impact on health outcomes for both mothers and their infants. DFMB has brought all of these important efforts together to work collaboratively.