For pregnant women in Louisiana with opioid addictions, shame and stigma can be overwhelming.
Six hours after Kemper Roach was born, it grew clear something was wrong.
The number of women in those situations has risen sharply over the past several years in Louisiana, and the rate of Louisiana babies exposed to opioids in the womb who later went through painful withdrawals quadrupled between 2005 and 2015. Women who have been through the ordeal have described struggling during their pregnancies to find acceptance and help to overcome their addictions.
Now, a new program is being launched in Louisiana that hospital leaders and state officials say they hope will address that problem.
The program was announced Tuesday by administrators from Woman’s Hospital, United Healthcare executives and local politicians. United Health Foundation will donate $1.2 million over three years to Woman’s for an initiative they expect to result in fewer drug-dependent babies who spend their first few days of life in intensive care, along with healthier moms in a better position to take care of them.
“We see the faces behind the staggering statistics," said Teri Fontenot, the president and CEO of Woman's, during a news conference Tuesday. "We see pregnant women who are so very willing, but unable, to overcome opioid misuse.”
In 2015, hospital discharge data showed at least 384 newborns in the state were diagnosed with the neonatal abstinence syndrome, which happens when a baby withdraws from opioids. And there were at least 1,681 validated cases of Louisiana newborns last year exposed to drugs or alcohol, according to the state's Department of Children and Family Services.
The program at Woman’s is called GRACE — Guiding Recovery and Creating Empowerment — and six pregnant women have already joined it. Health care providers can refer patients to GRACE, or women who know they need help can refer themselves.
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But that requires trust, which Heather Cianfrocco said is the key to making GRACE a success. Cianfrocco, CEO of UnitedHealthcare Community and State, flew into Baton Rouge from Minnesota for the Tuesday announcement.
"They've been stigmatized, judged and isolated," said Jena Ourso, a social worker at Woman's for GRACE. "We don't need to shame them anymore."
Ourso and Kiona Hayes, the nurse case manager for GRACE, said they usually begin their work with phone calls to find out more about the women misusing opioids. They ask if the women have OB-GYN care and whether they are interested in medication assisted treatment. And they perform a full assessment to find other problems that they may struggle with, like mental health disorders, a lack of access to housing and a desire for more education.
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The medication assisted treatment component is especially important, they said.
Clinicians advise treatment for many of those hooked on opioids — pregnant women included — that tempers cravings by replacing such drugs as heroin, fentanyl and Oxycontin with Subutex, Suboxone or methadone. Many doctors believe that a cold turkey drug withdrawal during pregnancy can result in stillbirths.
While many clinicians agree that it's better for women to be in a supervised program taking one of those medications rather than drugs from the streets, the medication can still be addictive and result in infants suffering from withdrawal symptoms.
None of the women enrolled in GRACE have given birth yet, but the program is designed to follow them through delivery as well. Ourso and Hayes said they will visit the women in the hospital, help them navigate the newborn and infant intensive care unit and check on them after they go home.
Clinicians monitor signs of withdrawal for opioids after babies are born, especially if the mother discloses opioid misuse or medication assisted treatment. Babies with neonatal abstinence syndrome are often fussy, jittery and unable to calm themselves. For newborns in deep distress, doctors will sometimes use morphine to stabilize them before weaning them off to go home.
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Cianfrocco said they hope to see a drop in newborn and infant intensive care unit admissions and costs by the end of the three-year period. She said the program at Woman's could become a model for other hospitals nationwide if the program is a success.
“This is a problem that needs to be solved, and nationally, we really don’t know the answer,” said Louisiana Department of Health Secretary Rebekah Gee, who is also an OB-GYN.
Gov. John Bel Edwards and East Baton Rouge Parish Mayor-President Sharon Weston Broome both celebrated the program as well, saying it is an example of a reason for optimism in Baton Rouge. Edwards referenced the biblical definition of “grace,” saying it gives people encouragement and good hope.
“With GRACE, we’re going to be able to reach more Louisianans, those that count on us the most,” the governor added.
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