Vermont Business Magazine Keeping mothers and babies safe in the midst of the opioid crisis in northern New England is the goal of a new online toolkit being tested in eight regional hospitals.The new collaborative program also encourages smoking cessation among this patient population in year two of a three-year, $127,000 grant that Dartmouth-Hitchcock’s Perinatal Addiction Treatment Program received from the March of Dimes in 2016.
Daisy Goodman, APRN:Women don't sign up to become addicts, and it's very important to keep that in mind when caring for them.
The number of infants born with neonatal abstinence syndrome (NAS) has increased as opioid use skyrocketed in the region, with heroin-related emergency room visits tripling in New Hampshire alone since 2013. By 2016, eight to 10 percent of newborns in the state’s Upper Connecticut Valley region had been exposed to opioids in utero and many had NAS, moderate to severe symptoms of physical dependence at the time of delivery.
While the number of addicted mothers and affected babies has increased, knowledge about how to treat them also has improved significantly, according to project coordinator Daisy Goodman, APRN, an advance practice nurse with a specialty in midwifery who works closely with the women in the Perinatal Addiction Treatment Program. “We’ve done some hard thinking about treatment versus a punitive approach, and I hope we’re moving as a nation in the direction of treatment and support and healing,” Goodman said. “Women don’t sign up to become addicts, and it’s very important to keep that in mind when caring for them.”
The new toolkit is a direct result of clinical evidence gathered over the past several years that showed a clear need for coordinated, compassionate care.
“In addition to NAS, untreated substance use disorders are associated with poor maternal and neonatal outcomes, including prematurity and infectious disease,” Goodman said. “Although evidence-based guidelines for the care of substance affected pregnancies are available, regional variation persists in the quality of care that is delivered and inconsistent coordination between maternity providers and addiction treatment providers continues to be a challenge.”
A survey of medical providers conducted last year by the Northern New England Perinatal Quality Improvement Network, a partner in the project, found that providers want consistent guidelines and a systematic approach to care, according to Goodman. “For example, they lacked a consent form that would help them coordinate care among providers,” said Goodman. “Providers were saying, ‘I feel like my patients have two different health care teams—they have their addiction treatment provider and they have their perinatal health care team and the two don’t talk to each other. This is not a safe situation.’ During the second year of this March of Dimes-funded project we will implement a toolkit that includes guidelines for best practice and the tools to incorporate them into our practices across the region."
While national work in this health care area has focused on “identifying and summarizing best practice through the work of expert consensus panels,” said Goodman, the northern New England initiative is taking a slightly different approach by focusing on getting those best practice recommendations into practice.“To my knowledge, we are the first to actively explore barriers and facilitators to implementing these guidelines into clinical practice across a variety of contexts,” she said. “For that reason, we hope this work will be helpful even outside of our New England region.”
Having focused on quality improvement of neonatal care in recent years, the March of Dimes is looking forward to the results of year two of this program, “Improving Safety and Quality in the Care of Pregnant women with Substance Use Disorders.”
“In the midst of a nationwide opioid abuse crisis, it is critically important that health care providers understand best practices for treating pregnant women and women of childbearing age, who often have very different needs from their other patients,” says Stacey D. Stewart, president of the March of Dimes.
Over the past year, Goodman worked with a regional advisory group of pediatric, maternity care and addiction treatment providers to create the toolkit. “The goal is to get providers and patients the information they need, for example, that it’s okay to breastfeed if you’re on methadone,” said Goodman, who noted that regional breastfeeding numbers vary widely due to lack of consistent patient information. “The toolkit will also remind clinicians about essential elements of good care, such as screening for Hepatitis C, which is not consistently done for this patient population even though a positive Hepatitis C test influences the management of labor and delivery and has significant downstream consequences for mom and potentially for baby.”
The toolkit also contains forms that enable a patient’s health care team to share information and collaborate better, as well as information about what the patient can expect when they go to the hospital to deliver their baby. “Many pregnant women with opioid use disorders don’t know that they and their babies will be drug-tested when they arrive at the hospital, for example,” said Goodman. “Information like this is essential in terms of the patient experience and the ability to generate trust. If they come in unprepared, it leads to anger and stress on all sides.”
Working on smoking cessation with this patient population is also an important focus of year two of the grant. “When babies have been exposed to nicotine prenatally this also causes withdrawal,” said Goodman, who added that tobacco also causes poor fetal growth, increases prematurity, and puts infants at risk for Sudden Infant Death Syndrome (SIDS), among other issues. “So we’re really pushing hard on the tobacco issue and working with the states through the Quitworks-NH, 802Quits, the Maine Tobacco Helpline and other resources.”
As communities across the country struggle with the impact of opioid use disorders, Goodman said she’s seen a change over the last three years in the way people in maternal child health are talking about opioid use in pregnancy. “I think we have a better understanding of the science of addiction and a better appreciation of medication assisted treatment as an evidence based approach during pregnancy,” Goodman said. “We’ve certainly grown in our understanding of the comparative efficacy of buprenorphine and methadone for treatment.”
“The March of Dimes has made it a priority to help and support women and infants affected by opioid abuse and other substances use disorders. We cannot and must not leave vulnerable moms and babies behind -- we must ensure they get every opportunity to live the healthiest lives possible,” Stewart said.
About March of Dimes
The March of Dimes is the leading nonprofit organization for pregnancy and baby health. For more than 75 years, moms and babies have benefited from March of Dimes research, education, vaccines and breakthroughs.For the latest resources and health information, visit our websitesmarchofdimes.orgornacersano.org. For detailed national, state and local perinatal statistics, visitperistats.org. You can also find us on Facebook and follow us on Instagram and Twitter.