The Opioid Epidemic and Maternal Health: Three Opportunities for Change
Opioid use disorder in pregnancy has increased dramatically across the country in the last decade, bringing with it increased health risks for mothers and babies. Mothers who don’t receive treatment are facing increased pregnancy complications, including increased risk for preterm births and low birth rates, and ultimately, more families are being separated, whether by needed social services or the tragic loss of a parent.
“These numbers oblige us to seize every opportunity to support families affected by the opioid crisis,” says NICHQ Chief Health Officer Elizabeth Coté, MD, MPH. “Each encounter a potential mother has with a care system—whether during gynecological care and screening, prenatal care and delivery, postpartum care or well child visits—is an opportunity for advocacy and change. Each encounter is a new chance, a potential moment for change that conveys hope.”
Improving these encounters is one area of focus for the National Network of Perinatal Quality Collaboratives (NNPQC), funded by the Centers for Disease Control and Prevention. NICHQ serves as the coordinating center for the NNPQC , which provides quality improvement expertise to state-based PQCs, helping them drive change in maternal and infant health outcomes across the country. Many of the PQCs in the network have identified opioid use disorder as a critical opportunity for improvement.
Below, we’re sharing ideas from NNPQC faculty experts—Ron Iverson, MD, MPH; Mike Marcotte, MD; Moira Crowley, MD; and Elisha Wachman, MD—on improving three potential encounters at three early stages of motherhood. Improving these interactions, especially for at-risk mothers, translates to more opportunities to help families when they are in crisis and in most need of additional aid.
In giving these families better support and more chances to make a change, public health professionals can better address the opioid epidemic and its damaging effects on maternal and infant health.
Prenatal opportunities: Screening and intervention
A woman’s first prenatal visit is a critical opportunity to screen for opioid use disorder. When the visit is managed well, a care provider can identify a mother’s addiction severity, offer initial information on the risks of continued illicit drug use, advise on next steps, and connect her with the supports she needs to heal (e.g., Medication-Assisted Treatment (MAT) providers, psychiatric care, social workers and local resources). However, without this supportive and compassionate approach, such screenings may be underutilized and ineffective.
“Women may feel nervous or uncomfortable bringing up their substance use,” says Iverson, the director of labor and delivery at Boston Medical Center (BMC). “It’s our job to be proactive about the screening and sensitive about how we respond. Establishing an initial rapport with these families, and acknowledging their unique experiences, brings needed trust.”
Similarly, says Iverson, care providers should never appear caught off guard when a mother discloses her opioid use. Acting surprised or judgmental can leave mothers feeling even more uncomfortable, making them less likely to trust recommendations or follow-up with concerns. Developing a standard plan for intervention helps ensure that providers are always prepared to give relevant, actionable and, perhaps most importantly, judgement-free advice.
Opportunities post-delivery: Empowering caregivers
After delivery, opioid-exposed newborns are often taken to intensive care for pharmacologic treatment, leaving mothers feeling alienated from their babies’ care.
“Rather than inspire change, this approach risks telling a new mother that she’s not capable of caring for her child,” explains Wachman, attending neonatologist at BMC. “We need to instead empower mothers as the primary treatment for their new babies. We can teach them how to console their babies, how to be a constant source of comfort and care.”
When care teams empower mothers on behalf of their own health and the health of their children, they improve long-term outcomes for families, all while helping babies recover at a faster rate. According to Wachman, this “nonpharmacologic” treatment approach—including rooming-in and breastfeeding, if not contraindicated—supports infant recovery and has reduced the length of stay and need for pharmacologic treatment in infants with neonatal abstinence syndrome by half at BMC.
Supporting mothers as caregivers also means being honest about their own treatment. This transparency helps realistically prepare mothers for recovery while establishing a foundation of trust between them and the healthcare system.
“Tell mothers what they can expect during that first hospitalization and prepare them to talk to social services,” says Crowley, the director of neonatal ECMO at the University Hospitals Rainbow Babies and Children’s Hospital in Cleveland. “Offering mothers realistic, honest advice positions you as a trusted ally, whereas letting them get blindsided might make them resistant to care.”
Postpartum opportunities: Supporting the dyad
When mothers return home, they’re often left battling their addiction while taking on the significant additional stress of a newborn. During that first year, relapse rates spike, bringing with them dire consequences.
“In many states, accidental overdose is the leading cause of maternal death in that first year,” says Marcotte, director of quality and safety for women’s services at TriHealth in Cincinnati. “We’re losing too many mothers because they don’t have a support system. We can change that, though, by partnering with pediatricians to help support post-discharge care.”
While a mother may not follow up with her own care, she is likely to follow up with her child’s. Pediatric visits then become critical opportunities to discuss addiction treatment and needs, such as coordinating sub-specialists and social services, and directing mothers to additional community support networks. Forwarding a two-generational approach at these visits—one that prioritizes comprehensive care of the mother-child dyad—provides another critical opportunity to support families, another chance to inspire change.
“We have to remember that these families often face significant barriers to optimal health, such as trauma, poverty and access to healthcare,” says Coté. “Addiction is a chronic disease marked by relapse. But by aligning systems of care and transforming every interaction into an opportunity for change, we’ll come closer to providing these families with the wrap-around services they need to recover and heal.”
NICHQ Employee Spotlight: Joshua Licursi
Each month, we’re shining a spotlight on a NICHQ employee. Here, Communications Specialist Joshua Licursi shares how his work at NICHQ combines his life-long passion for communications with public health marketing.
Continuing Sickle Cell Disease Care During the COVID-19 Pandemic
People who have sickle cell disease and very vulnerable to COVID-19 impact. As we enter the fourth month of the pandemic in the U.S., we’re sharing how providers and advocates have remained nimble to ensure that comprehensive and consistent care is maintained throughout the pandemic and beyond.
An Introduction to Measuring Reliability
Measuring reliability enables us to understand the effectiveness of our health systems and initiatives and discover where improvements are needed. Not sure where to start? We're sharing an introduction to measuring and increasing reliability in your projects and initiatives.
Making Fathers Visible in Maternal and Child Health
From cognitive and social emotional development to education and accomplishments, children with involved fathers achieve better health outcomes. Yet despite fathers’ positive impact on maternal and child health, many of the systems intended to serve women and children were not designed with fathers in mind. That’s why we’re sharing strategies to increasing father involvement in early childhood programs.
NICHQ Employee Spotlight: Barbara Lambiaso
Each month, we’re shining a spotlight on a NICHQ employee, asking them to share their memories, advice, and goals. Project Manager Barbara Lambiaso shares her commitment to various NICHQ projects, including an initiative that serves children and adults with sickle cell disease.
Racial Inequality and Injustice and the Health of America’s Children
Our nation is hurting. Many are afraid, angry, anxious, and frustrated as we witness institutional racism and social injustice, once again, ravaging communities of color. NICHQ CEO Scott D. Berns calls for meaningful change to end to systemic racism and injustice in our country.