Long-term Support for Moms, Babies Affected By Opioids

Beverly Hospital launching new program with help of $1M state grant 

Neonatologist Jennifer Lee, MD, examines a week-old baby experiencing symptoms of neonatal abstinence syndrome at Beverly Hospital.

Dozens of expecting moms struggling with addiction will soon get the support they need to navigate the harmful combination of pregnancy and substance abuse.

Nicole Sczekan understands the danger – and lack of support for pregnant moms with addiction – firsthand. Sczekan, a certified nurse midwife at Beverly Hospital, often felt helpless during her daughter’s ongoing battle with opiate addiction. Her daughter’s pregnancy presented a window of opportunity.

“I was seeing that this was the opportune time to intervene because she was going to her medical appointments and she wanted to do the right thing,” said Sczekan. “I was so frustrated for her that treatment for addiction wasn’t incorporated into prenatal care.”

Sczekan’s daughter, now 25, did start methadone maintenance treatment while pregnant to help her stay off heroin. Six years later – despite some ups and downs – she’s still clean.

Drawing on her own experience, Sczekan saw an opportunity to do more to help women like her daughter as well as the opioid epidemic’s smallest victims: their babies. Along with two colleagues – Melissa Sherman, MD, an OB-GYN, and Jennifer Lee, MD, a neonatologist – she designed a program to identify at-risk moms and support them with judgment-free care during pregnancy and after, giving them and their babies the best chance to thrive. The program at Beverly Hospital, a Lahey Health hospital, was recently awarded a $1 million grant from the Massachusetts Health Policy Commission.

The project is still in the planning stages, the first patients are expected to be on-boarded by the end of the year. Plans include caring for approximately 35 women and babies annually for during the two-year grant period.

Statistics paint a grim picture of the effects of the opioid epidemic on mothers and babies. An August report from the CDC revealed the number of babies born in the country addicted to opioids has tripled over the past 15 years. Locally, Beverly Hospital admitted 68 infants and 67 mothers between 2014-15 for treatment of neonatal abstinence syndrome (NAS), the effects of which can include delayed physical or emotional development, low IQ and seizures caused by withdrawal.

Only 61 percent of the mothers who were admitted to the hospital for NAS treatment had prenatal care in their first trimester, while 15 percent had no prenatal care at all. Yet studies show that the babies of women who do have regular prenatal care, maintenance medication and addiction treatment experience less severe NAS, Sczecan said.

“The main strategy of the program is acceptance and having a safe place where they can come. Most moms want help, but they’re afraid.” Sczekan said. “They believe they can stop on their own, and by the time they realize they need help they are often several months pregnant. We want women to know this is a safe place to find help as soon as they find out they are pregnant. We want them to know there is hope for recovery.”

Through the new program, clinicians will follow pregnant women from their first prenatal appointment to a year after giving birth with an integrated approach including medication-assisted therapy, group and individual therapy, standard prenatal care, childbirth and childcare education, and frequent follow-ups after birth.

“One key piece of it is the medication assisted therapy,” Sherman said. “If you’re going to try to address all these things at once, the obstetrician should be prescribing the medication — either buprenorphine or methadone. We understand the stresses and strains that come with all pregnancies.”

Additionally, group and individual counseling that is gender-specific can help women learn to cope with the underlying cause of their drug use, which may be anxiety, depression, abuse, trauma or simply an inability to cope with their current situation.

Postpartum follow up-care is also critical to long-term success.

“With the follow-up clinic, we will be able to stay involved with the families and better monitor the impact on growth and development,” said Lee, one of the program’s co-founders. “Right now, a lot of the moms don’t follow up after they have their babies. If we can keep moms in treatment for the first year, we can improve their use of other important services like early intervention, which can help to keep the infants' development on track.”