[Music]
so I used to believe that drug addicts
were lesser people lesser people and
that they could get over their problem
if they were just a little bit motivated
I felt that way because that’s what my
parents and teachers taught me as a kid
and society has since then reinforced
that view this mindset has led to
individuals with addiction being the
most stigmatized group in our culture I
would say the equivalent of modern-day
lepers some people will say just write
them off this is a tragedy but it’s one
with a possible happier ending as a
practicing neonatologists here in
Columbus my goal has been to have
healthy newborns as concerned citizens I
think we all share the goal that these
back all moms and babies should have the
best possible future today I want to
talk to you about a program that
reinforces the maternal newborn bond it
promotes healthy families and it helps
women deal with their addiction issues
the illicit opiate problem it continues
to grow and with it more and more babies
are exposed in utero to maternal opiate
use when I first came to Columbus a
dozen years ago I would see maybe just
three or four babies a year who had been
exposed to maternal opiates and now I
see about 200 per year the Ohio
Department of Health has reported that
on average there are 84 newborns
withdrawing from maternal opiates in an
Ohio Hospital each day
let’s openly admit why it can be
difficult to be non-judgmental when we
think about a mom who abuses drugs
it can be heartbreaking to see a baby
with dry infamous mothers opiates the
baby can cry inconsolably for hours and
have trouble getting any sleep
in this scenario we tend to view the mom
as a villain as if she decided that her
drug abuse was more important than the
needs of her baby but now we know that
mom herself is the victim of a chronic
neurological disease and by adjusting
our attitudes towards addiction we can
have improved outcomes for both moms and
their babies when I was in medical
training I was taught that drug addicts
were highly manipulative drug seekers
and only a rigid rules approach to give
them the guidance they needed to improve
we were told that we would look foolish
to everyone if we tried to work
cooperatively with them
but now we know that addiction is
actually the expression of a disease
process and there are specific genes
that have been identified in certain
susceptible individuals that we know
places them at higher risk of addiction
so let’s be clear for a moment how most
addicts get started
typically it begins with a physician’s
prescription for painkillers following a
surgery or a traumatic event and when
that susceptible individual runs out of
pills they discover that they’re
starting to go through withdrawal and in
order to continue to be able to function
as a parent the spouse or an employee
they need to find alternative sources of
opiates and that typically inevitably
leads to illicit drug seeking behavior
the other group at particularly high
risk are those who have under treated
mental health issues especially when
accompanied by highly stressful social
situations blaming these individuals for
their drug addiction is like blaming the
person who has epilepsy or dwarfism and
compounding the problem the stigma
associated with addiction makes it very
difficult for these people to seek out
the treatment they need typically when a
woman becomes pregnant she might decide
to lead a healthier lifestyle and I
think we’ve all known people who have
given up caffeine or cigarettes and so
my mom’s may try to give up illicit
drugs unfortunately we must discourage
complete opiate abstinence in opiate
addicts during pregnancy because it can
be dangerous for the baby to withdrawal
inside of mom so the preferred method is
to replace moms illicit opiates like
heroin with prescribed methadone or
suboxone which is an opiate replacement
therapy that can remove much of the drug
seeking craving in the mom allow her to
have improved nutrition and better
prenatal care
this medication however does not prevent
the risk of withdrawal in the baby after
birth so when a woman delivers the
hospital is going to be using a scoring
system to look for the presence and to
assess the severity of the babies
withdrawal and this scoring system looks
at things like excessive crying or
excessive sucking spitting up after
feeds or watery stools but of course
these are symptoms that all babies can
display to one degree or another and so
what we found is that the scoring system
tends to create an adversarial
relationship between the new mom and the
healthcare team which really prevents us
from establishing good rapport and
getting good parental teaching of safe
newborn care if the baby scores too high
then he’s transferred to the Nina
intensive care unit where he can be more
closely monitored and received
medication to control his symptoms the
unfortunate consequence of NICU
admission is that mom and baby are now
physically separated and we’ve
interrupted that golden opportunity to
establish a strong maternal infant bond
typical NICU stay for this disorder is
going to be about two weeks and imagine
how – how long that two weeks must seem
to the woman who has other children at
home or who maybe has transportation
challenges and finds it difficult to
visit her baby while in the NICU and
imagine how frustrating it must be for
her when this is the outcome after she
did all the difficult difficult things
we asked her to do during the pregnancy
like giving up her addictive substance
attending to more frequent doctor visits
remembering to take a daily medication
and answering a lot of probing questions
from judging professionals upon and I
see you discharged about 80% of these
babies will go home with their mom but
we’ve interrupted the maternal newborn
bond often times and for some we’ve
really ruined mom’s confidence in her
ability to take care of her baby
comfortably and unfortunately with
current traditional care about half of
the babies whose moms are in drug
treatment need to go this and ICU relp
so in 2012 I was lucky enough to hear
dr. Ron Abraham speak about an amazing
program he had at the first Center in
Vancouver Canada for addicted moms and
their babies
he used the care model called harm
reduction which recognized that if
addiction is truly a chronic medical
condition then it’s unrealistic to
expect an immediate here one would not
expect an immediate curve for diabetes
or for hypertension and so it’s not fair
in addiction either but he discovered
that if he could have gradual
improvement in these moms on a
continuous basis and in the beginning
eliminate the most risky behaviors then
he could really make a huge impact and
have improved outcomes being part of the
Canadian province system
he had his funding through the province
and he was able to keep many of his moms
in the hospital for as much as two weeks
before in two weeks after delivery and
he had many more good outcomes than we
were used to seeing here so it seemed
like we had the opportunity to improve
what we did and this inspired a group of
us to get together to see whether we
could create a program that provide
comprehensive prenatal care and a
family-centered approach after delivery
he right here in Columbus we were
fortunate to be given a moms grant from
the state of the hub from the state of
Ohio and that allowed for the creation
of the mother infant recovery clinic so
this clinic was open 1/2 day per week
it provided prenatal care medication
assisted therapy and group counseling
all in one setting and there were also
community peer mentors that were
available to these moms for the rest of
the week we held a local all-day
conference for nurses where we
introduced the concept of addiction as a
chronic medical disease and we gave them
instruction on how they can be
supportive to mom and being able to
soothe her own baby
utilizing techniques like skin the skin
care and breastfeeding as much as
possible we tried to have all the babies
care brought to Mom’s room avoiding the
loud and brightly lit well baby nursery
and we tried to provide the babies care
on the baby schedule rather than the
hospital schedule the results of this
pilot project were really startling we
found that 90% of these of these 38 moms
and babies in this pilot project 90%
were
able to go home directly from the
postpartum floor after just three to
five days of observation and whereas
typically we were sending half of these
babies to the NICU we only sent four of
them to the NICU and in most of those
cases those were moms who were
physically too ill after delivery to be
able to take care of their babies when
we followed these infants after
discharge
none of them required inpatient or
outpatient management for withdrawal
symptoms so I think there’s some real
significant advantages to what we found
in this program first the moms were
confident in their ability to care for
their babies and they had learned
soothing techniques that they they can
then use at home when the baby became
irritable we didn’t interrupt that
period of maternal newborn bonding which
should lessen our risk about the
potential for child abuse and neglect my
avoiding prolonged and costly
and ICU care there were huge financial
savings and lastly women who were able
to successfully transition the
motherhood now had the additional
self-confidence that they could go on
and continue to address their own
addiction disease so we know that the
greatest predictor of long-term
successful child development is being
present in a stable and loving family
while we continue to argue about the
best way to address the opiate crisis
there’s tens of thousands of women and
their children caught in the crossfire
this project with coordinated prenatal
care and a family-centered approach
after delivery required no expensive
equipment and it should be easily
scalable to other delivery facilities
but proper prioritization of funding is
now needed to allow for that growth to
occur
I think it’s time for us to advance our
attitudes about addiction to agree with
the science and allow these women and
children to have the brightest future
possible thank you
[Applause]
so I used to believe that drug addicts
were lesser people lesser people and
that they could get over their problem
if they were just a little bit motivated
I felt that way because that’s what my
parents and teachers taught me as a kid
and society has since then reinforced
that view this mindset has led to
individuals with addiction being the
most stigmatized group in our culture I
would say the equivalent of modern-day
lepers some people will say just write
them off this is a tragedy but it’s one
with a possible happier ending as a
practicing neonatologists here in
Columbus my goal has been to have
healthy newborns as concerned citizens I
think we all share the goal that these
back all moms and babies should have the
best possible future today I want to
talk to you about a program that
reinforces the maternal newborn bond it
promotes healthy families and it helps
women deal with their addiction issues
the illicit opiate problem it continues
to grow and with it more and more babies
are exposed in utero to maternal opiate
use when I first came to Columbus a
dozen years ago I would see maybe just
three or four babies a year who had been
exposed to maternal opiates and now I
see about 200 per year the Ohio
Department of Health has reported that
on average there are 84 newborns
withdrawing from maternal opiates in an
Ohio Hospital each day
let’s openly admit why it can be
difficult to be non-judgmental when we
think about a mom who abuses drugs
it can be heartbreaking to see a baby
with dry infamous mothers opiates the
baby can cry inconsolably for hours and
have trouble getting any sleep
in this scenario we tend to view the mom
as a villain as if she decided that her
drug abuse was more important than the
needs of her baby but now we know that
mom herself is the victim of a chronic
neurological disease and by adjusting
our attitudes towards addiction we can
have improved outcomes for both moms and
their babies when I was in medical
training I was taught that drug addicts
were highly manipulative drug seekers
and only a rigid rules approach to give
them the guidance they needed to improve
we were told that we would look foolish
to everyone if we tried to work
cooperatively with them
but now we know that addiction is
actually the expression of a disease
process and there are specific genes
that have been identified in certain
susceptible individuals that we know
places them at higher risk of addiction
so let’s be clear for a moment how most
addicts get started
typically it begins with a physician’s
prescription for painkillers following a
surgery or a traumatic event and when
that susceptible individual runs out of
pills they discover that they’re
starting to go through withdrawal and in
order to continue to be able to function
as a parent the spouse or an employee
they need to find alternative sources of
opiates and that typically inevitably
leads to illicit drug seeking behavior
the other group at particularly high
risk are those who have under treated
mental health issues especially when
accompanied by highly stressful social
situations blaming these individuals for
their drug addiction is like blaming the
person who has epilepsy or dwarfism and
compounding the problem the stigma
associated with addiction makes it very
difficult for these people to seek out
the treatment they need typically when a
woman becomes pregnant she might decide
to lead a healthier lifestyle and I
think we’ve all known people who have
given up caffeine or cigarettes and so
my mom’s may try to give up illicit
drugs unfortunately we must discourage
complete opiate abstinence in opiate
addicts during pregnancy because it can
be dangerous for the baby to withdrawal
inside of mom so the preferred method is
to replace moms illicit opiates like
heroin with prescribed methadone or
suboxone which is an opiate replacement
therapy that can remove much of the drug
seeking craving in the mom allow her to
have improved nutrition and better
prenatal care
this medication however does not prevent
the risk of withdrawal in the baby after
birth so when a woman delivers the
hospital is going to be using a scoring
system to look for the presence and to
assess the severity of the babies
withdrawal and this scoring system looks
at things like excessive crying or
excessive sucking spitting up after
feeds or watery stools but of course
these are symptoms that all babies can
display to one degree or another and so
what we found is that the scoring system
tends to create an adversarial
relationship between the new mom and the
healthcare team which really prevents us
from establishing good rapport and
getting good parental teaching of safe
newborn care if the baby scores too high
then he’s transferred to the Nina
intensive care unit where he can be more
closely monitored and received
medication to control his symptoms the
unfortunate consequence of NICU
admission is that mom and baby are now
physically separated and we’ve
interrupted that golden opportunity to
establish a strong maternal infant bond
typical NICU stay for this disorder is
going to be about two weeks and imagine
how – how long that two weeks must seem
to the woman who has other children at
home or who maybe has transportation
challenges and finds it difficult to
visit her baby while in the NICU and
imagine how frustrating it must be for
her when this is the outcome after she
did all the difficult difficult things
we asked her to do during the pregnancy
like giving up her addictive substance
attending to more frequent doctor visits
remembering to take a daily medication
and answering a lot of probing questions
from judging professionals upon and I
see you discharged about 80% of these
babies will go home with their mom but
we’ve interrupted the maternal newborn
bond often times and for some we’ve
really ruined mom’s confidence in her
ability to take care of her baby
comfortably and unfortunately with
current traditional care about half of
the babies whose moms are in drug
treatment need to go this and ICU relp
so in 2012 I was lucky enough to hear
dr. Ron Abraham speak about an amazing
program he had at the first Center in
Vancouver Canada for addicted moms and
their babies
he used the care model called harm
reduction which recognized that if
addiction is truly a chronic medical
condition then it’s unrealistic to
expect an immediate here one would not
expect an immediate curve for diabetes
or for hypertension and so it’s not fair
in addiction either but he discovered
that if he could have gradual
improvement in these moms on a
continuous basis and in the beginning
eliminate the most risky behaviors then
he could really make a huge impact and
have improved outcomes being part of the
Canadian province system
he had his funding through the province
and he was able to keep many of his moms
in the hospital for as much as two weeks
before in two weeks after delivery and
he had many more good outcomes than we
were used to seeing here so it seemed
like we had the opportunity to improve
what we did and this inspired a group of
us to get together to see whether we
could create a program that provide
comprehensive prenatal care and a
family-centered approach after delivery
he right here in Columbus we were
fortunate to be given a moms grant from
the state of the hub from the state of
Ohio and that allowed for the creation
of the mother infant recovery clinic so
this clinic was open 1/2 day per week
it provided prenatal care medication
assisted therapy and group counseling
all in one setting and there were also
community peer mentors that were
available to these moms for the rest of
the week we held a local all-day
conference for nurses where we
introduced the concept of addiction as a
chronic medical disease and we gave them
instruction on how they can be
supportive to mom and being able to
soothe her own baby
utilizing techniques like skin the skin
care and breastfeeding as much as
possible we tried to have all the babies
care brought to Mom’s room avoiding the
loud and brightly lit well baby nursery
and we tried to provide the babies care
on the baby schedule rather than the
hospital schedule the results of this
pilot project were really startling we
found that 90% of these of these 38 moms
and babies in this pilot project 90%
were
able to go home directly from the
postpartum floor after just three to
five days of observation and whereas
typically we were sending half of these
babies to the NICU we only sent four of
them to the NICU and in most of those
cases those were moms who were
physically too ill after delivery to be
able to take care of their babies when
we followed these infants after
discharge
none of them required inpatient or
outpatient management for withdrawal
symptoms so I think there’s some real
significant advantages to what we found
in this program first the moms were
confident in their ability to care for
their babies and they had learned
soothing techniques that they they can
then use at home when the baby became
irritable we didn’t interrupt that
period of maternal newborn bonding which
should lessen our risk about the
potential for child abuse and neglect my
avoiding prolonged and costly
and ICU care there were huge financial
savings and lastly women who were able
to successfully transition the
motherhood now had the additional
self-confidence that they could go on
and continue to address their own
addiction disease so we know that the
greatest predictor of long-term
successful child development is being
present in a stable and loving family
while we continue to argue about the
best way to address the opiate crisis
there’s tens of thousands of women and
their children caught in the crossfire
this project with coordinated prenatal
care and a family-centered approach
after delivery required no expensive
equipment and it should be easily
scalable to other delivery facilities
but proper prioritization of funding is
now needed to allow for that growth to
occur
I think it’s time for us to advance our
attitudes about addiction to agree with
the science and allow these women and
children to have the brightest future
possible thank you
[Applause]
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