Saturday, September 9, 2017

UK program that cares for addicted moms and their babies during and after pregnancy could become new model of care for nation

Mya Slone, a mother in the program
(Photos by Cassandra Giraldo, Vice News)
Kentucky Health News

An innovative program in Lexington that treats addicted babies, while making sure the moms aren't using drugs, has shortened hospital stays for the infants and empowered the mothers to be part of their care.

As part of a series of stories titled "A Nation in Recovery,"  Keegan Hamilton of Vice News paints a picture of what it's like to be pregnant, addicted to painkillers and heroin and having to make the hard choice to continue on a prescribed medication that is also an opioid -- just like heroin -- that helps her not use drugs or go cold turkey and risk relapse.

The story follows Mya Slone, identified only as a 26-year-old from "rural Kentucky" 34 weeks pregnant with her third child, through the last weeks of her pregnancy as she participates in the innovative PATHways program. She told Hamilton that she had almost lost her kids because of her drug use, and was determined not to let that happen again, even if it meant continuing on her buprenorphine, also known as Suboxone or Subutex.

The drug would ease Slone's cravings and would likely reduce the chances that the baby, a girl she planned to call Emma Grace, would be born addicted and have withdrawal, but that risk isn't entirely eliminated, Hamilton reports. “I don’t want her to have to go through that,” said Slone.

But under the care of a physician, they both agreed that it was the right decision to take the Subutex -- though no-one but her fiancé, who was also recovering from heroin addiction, knew about it and Slone was afraid to tell them.

Hamilton goes into detail about the struggles pregnant women with addiction face, including the stigma that surrounds medication-assisted therapies, laws that can put pregnant addicts in jail, the guilt and shame and the real fear that their kids will be taken away.

Vice News chart
But it's a problem that's not going away. The number of babies born with Neonatal Abstinence Syndrome, the medical term for babies who are born addicted to drugs, "has overwhelmed the medical system, and many intensive care units for newborns are at capacity," Hamilton writes. The rate of babies being born with NAS has increased 400 percent since 2000, with one baby born with the syndrome every 25 minutes. In Kentucky, one out of every 50 newborns has NAS.

“You go to Tennessee, Kentucky, West Virginia — they’re building special hospital units for these kids,” Matthew Grossman, a pediatrician at Yale-New Haven Children’s Hospital and a Yale Medical School professor, told Hamilton. “It’s become a major, major issue.”

The program, called PATHways, is "one of only a handful nationwide," but is "shifting the paradigm," Hamilton writes. It is a " one-stop shop for pregnant women in recovery, offering counseling, medication-assisted treatment, prenatal care, and parenting classes."

Kristin Ashford, UK College of Nursing, an architect of program
The program was created in 2014 by an all-female team of four doctors and nurses with the University of Kentucky, Hamilton reports, adding that more than 190 women have participated since it opened, and only one has tested positive for illicit opioids at her child's birth.

"It’s the type of care that every woman in Slone’s shoes deserves," he writes. "And if it becomes the norm, it could help break the cycle of addiction."

Hamilton continues the story with detailed explanations of how PATHways differs from a traditional plan of care for babies born with NAS, including keeping the mother and baby in the same room instead of treating the baby in the ICU and sending the mom home, and using a holistic approach to sooth the addicted babies, like swaddling and a special type of massage, instead of immediately using opioids to wean the baby from their addiction.

“The real key to babies doing well is being with their mothers,” said Lori Shook, a neonatologist involved with PATHways. “We’re empowering them rather than taking their babies away.”

The new approach is working. "The average length of stay for NAS babies in her NICU has decreased from 29 days to six, and 97 percent of the babies who stay with their mothers during treatment require no opioid medications," Hamilton writes.

Hamilton notes that PATHways learned early on that these moms continue to need support long after their babies are born and have adjusted it to follow them up until two years post-partum.

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