There can be many complications during pregnancy, from gestational diabetes to hypertension. But some women are entering into motherhood with an even greater challenge to their health and the baby’s: drug addiction.
The Ohio Department of Health says there were about 84 infants a day being treated for drug withdrawal in 2015, the most recent data available. Health officials say caring for newborns suffering from the syndrome was associated with more than $133 million in health system charges that year.
Through the Helping Opiate-addicted Pregnant women Evolve (HOPE) program, TriHealth strives to provide safe and non-judgmental care to chemically dependent women in the Cincinnati area.
“I’ve worked with over 1,000 pregnant women who have opioid use disorder in our program, and they almost all come to us with the same desire – they want to be in treatment so they can stop using illicit opiates and start getting into recovery,” says Michael Marcotte, MD, director of the HOPE program based at Good Samaritan Hospital in the TriHealth network.
The HOPE Program supports comprehensive prenatal care integrated with chemical dependency treatment to reduce the rate of low birth weight in this population and improve the percentage of patients who remain substance-free during and after their pregnancy. HOPE is one of four programs supported by the State of Ohio MOMS (Maternal Opiate Medical Supports) program, an investment of $2 million across the state to improve health outcomes for opioid-dependent pregnant mothers.
“This time in their lives is a pivot point; it is an opportunity. It is an opening for them to engage in effective treatment for their chronic disease of opioid use disorder and for us to connect them to resources that are effective.” - Dr. Michael Marcotte
The majority of the women want to parent, says Marcotte, but there are many barriers for them. Not only are they struggling to overcome their own diseases, but there is often the involvement of criminal justice systems and the Department of Job and Family Services to protect these vulnerable children. To help overcome these barriers, Marcotte and the HOPE team focus on the “triple aim” model of health care delivery: evidence-based care, cost-effective care, and patient-centered care.
“We do a lot of care coordination with other partners, like medication-assisted treatment programs and behavioral health programs,” says Marcotte. “We specifically focus on trying to build a treatment program that will allow women and their families to obtain the goals they have set for themselves. We’re all about empowering the women to be successful in achieving their goals.”
The HOPE team includes social workers, nurses, case managers, a midwife, faculty at the medical center, obstetricians and OB/GYN residents. Each team member works with the mom-to-be at different stages, from helping her get into treatment to managing pregnancy complications to delivery and postpartum care, including long-term behavioral health care.
“You don’t get an opioid use disorder just because you took some pills, or because you experimented with drugs. You get it because of multiple factors, one of them being a lot of trauma and loss in your life." - Dr. Michael Marcotte
“To get to recovery – to get to a healthy, productive life – you have to go down the journey of healing and it can’t be done with just a prescription. Our best providers of addiction treatment are the ones who recognize and hold that philosophy,” says Marcotte.
Marcotte says the most effective treatment of opioid use disorder is flexible and customizable. It has to include collaboration with other programs that provide behavioral health at all levels, in addition to medication-assisted treatment.
“It is like a microcosm of the larger problem in terms of complexity of care that has to be provided to get to good outcomes,” Marcotte says. “If we could do well on this, it could be an example for Ohio’s larger, general population.”
To learn more about the State of Ohio MOMS program and supported programs like HOPE, visit www.momsohio.org.
Tessie Pollock is director of communication at the State Medical Board of Ohio. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Michael Marcotte, MD is a staff Perinatologist in the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology at Good Samaritan Hospital. Dr. Marcotte earned his medical degree from the Medical College of Ohio in Toledo in 1991. He then performed his internship, residency and Maternal-Fetal Medicine Fellowship at the Medical College of Ohio. He is a fellow of the American College of Obstetricians and Gynecologists. He is a member of the Society of Maternal-Fetal Medicine, the American Medical Association and the Cincinnati Academy of Medicine. Dr. Marcotte is subspecialty board certified in Maternal-Fetal Medicine. In 2009, he was appointed to be the Director for Quality in Maternity Services at TriHealth and spends about 25 percent of his time working on quality improvement in obstetrics. Quality improvement is also his focus in perinatal research. He is the co-chair of the perinatal research advisory committee at TriHealth.
