Perinatal Hope: Helping Mothers Who Have Substance Use Disorder

• By:  Corey Florindi
• Posted:  November 19, 2018
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The Allegheny Health Network (AHN) has many programs designed to address the health challenges of specific populations. One inspiring example is the Perinatal Hope Program. Based out of West Penn Hospital in Pittsburgh, and serving women throughout the region, Perinatal Hope helps expectant mothers who are struggling with substance use disorders.

Deb McDonald, MSN, RN, director of women’s health programs at AHN, has been deeply involved in developing and operating Perinatal Hope, which officially launched in 2016. She generously took time from her busy schedule to talk with me about how the program started and how it works. It was clear throughout that she is passionate about helping the women and children this program serves.

Responding to an Emerging Crisis

Corey Florindi (CF): How did the Perinatal Hope Program get started?

Deb McDonald, MSN, RN (DM): Even before there was so much media coverage around the opioid epidemic, we were seeing more pregnant women who needed specialized help because of substance use disorders. That also meant more babies born with neonatal abstinence syndrome, including some we had to keep at the hospital for 30 days or more as they went through withdrawal.

The problem was clear, and getting worse, so we were looking for the best ways to help. We did a lot of research and networking with other groups in the community, but the most important thing was sitting down and talking with the women themselves to find out what was happening in their lives. That gave us insights about how much they were struggling because they had to navigate a lot of this journey alone and weren’t getting the support or information they needed.

Because of what we learned, we designed Perinatal Hope to be a “one-stop shop” that brings together different services and health care professionals and educational materials, so these women get maximum support from a visit. They get their OB-GYN exam, but we’re also providing medication-assisted treatment, drug and alcohol counseling, and filling their prescriptions. We have them come in weekly to start, and then if they’re strong enough and on their way to recovery, we go to two weeks.

That’s the basis of our program, but there’s much more. With substance use disorders, there’s no one isolated problem that you can attack and be done with it. For example, if we see someone struggling with transportation, we’ll work with Traveler’s Aid to get that patient the transportation she needs. If a woman wants help and wants to get better, we should do everything we can to support her, not add new challenges for her to figure out.

CF: It sounds like a very personalized approach.

DM: In a sense, it has to be. There’s a misconception that substance use disorders are limited to certain demographic groups, but people in health care can tell you there is no one type of person. Substance use disorders affect black, white, young, old, rich, poor. So we have to look at the individual and what might have brought them to where they are, and then decide what is best for each patient.

CF: Do the misconceptions, and stigma, around substance use disorders, make it harder to get women the help they need?

DM: Sure. One woman who successfully went through our program, and is training to become a peer recovery specialist, also sits on Perinatal Hope’s steering committee. She has been there, she knows other women who have gone through this, and she will tell you that one of the biggest fears is that if they admit they have a problem their child will be taken away, or they’ll get in legal trouble, or they’ll be treated as less than a person. That might mean they don’t reach out for help at all, so it’s vitally important that we provide a nonjudgmental, supportive, trustworthy atmosphere.

We worked to educate all of our OB units and staff so everyone understands better what we’re dealing with, and what we’re trying to achieve. Substance use disorder is an illness. If someone has diabetes, we don’t tell them we won’t treat them unless they stop eating sugar. We don’t refuse to help them if they maybe messed up and their blood sugar lands them in the hospital. It’s the same for people with substance use disorder. I’m not saying we need to condone substance use or any other unhealthy behavior, but our priority is helping people get better, not judging.

We work with the Pennsylvania Organization for Women in Early Recovery, or POWER, to provide drug and alcohol counseling. We talk with each woman and find out what they need. If a patient has a setback, we don’t give up, we look at what we can adjust — again, just as we would with someone struggling through diabetes or any other disease. Whether it’s counseling, our intensive outpatient treatment, or inpatient treatment, or some other support, there are options, and we’ll work with each patient until they get the help that’s right for them.

Centering Pregnancy and Empowering Through Education

CF: Let’s talk more about specific ways that Perinatal Hope helps women with substance use disorder during pregnancy. A press release on the program mentions Centering Pregnancy — what exactly is that?

DM: CenteringPregnancy^® is a prenatal care model that combines prenatal exams with clinician-led group education and sharing sessions. This is a natural fit with wanting Perinatal Hope to be a one-stop-shop for the women we serve. So, when a woman comes in for her regularly scheduled prenatal appointments, in addition to the other support we’re offering around substance use disorders, she can also attend free Centering Pregnancy classes. We cover a range of information in these classes, and each patient gets a notebook to write down things about their life and what’s going on, so the classes are also an opportunity to share thoughts, questions and experiences.

To give you a taste of what we cover in centering classes, we have an anesthesiologist come and talk to our patients about pain control, and what’s going to happen when they’re in labor and delivery, what happens if they need a cesarean section. This can be an extra fear for some of our women because their pain receptors may be different due to their substance use.

Our lactation consultant talks with them about breastfeeding, and we have neonatologists provide information on what to expect with a baby going through neonatal abstinence syndrome and ways to soothe their newborns when they go home.

Another class involves our women’s behavioral health team. They’ll talk about issues the moms-to-be might be anxious about. This also reinforces that the team is there to help with anything they need. A lot of women in our program have other trauma issues in their lives, such as adverse childhood events, rape or abuse. The women’s behavioral health team can help with perinatal depression, bipolar disorder, anxiety, or any other mental health challenges.

So those are the classes. In an even larger sense, centering a woman’s pregnancy is the idea behind everything we do. We put that pregnant woman at the center and then surround her with care and support. A main problem this population faces is that resources aren’t readily available and it may be difficult for them to balance and get to multiple appointments every week. Our goal is to make it as easy as possible for them to get what they need.

CF: A lot of what you mentioned is about giving women information and knowledge, not just medical services.

DM: There is a very strong education component to Perinatal Hope. We try to teach mothers about what to expect through every aspect of pregnancy, giving birth, and the postpartum period, and how to handle it all while also managing their recovery from substance use disorder.

We take that same approach to family planning. Over 90 percent of women in our program did not plan to become pregnant. So that’s part of our program — we’re not here to tell them whether to have another child or not, but we make sure they have family planning information and know their options, that they have a plan for after they deliver, and that they don’t have to jump through hoops to get services.

Bringing Perinatal Hope to the Community

CF: Is the Perinatal Hope Program just at West Penn Hospital?

DM: We started our pilot in 2016 at West Penn Hospital, but the success has allowed us to continue expanding. Dr. Allan Klapper, who is chair of the AHN Women and Children Institute, has been so supportive of moving the program out to more communities. This is part of AHN’s larger mission as well — to get care out to the people we serve instead of making them come into the city. So we now have a Perinatal Hope site at Jefferson Hospital, at Forbes Hospital with Family Medicine, Federal North on the city’s north side, and we are also moving out to the Mon Valley and Natrona Heights.

There are so many people involved in making this program possible, including doctors and nurses at each of these locations. But I especially want to mention that Dr. Mark Caine was really a driving force in how the program was created on a patient-centered medical home model. He and Dr. Eric Lantzman are the lead doctors for the program. Ashley Schultz, who’s the program coordinator, and Katrina Siders, who’s a nurse practitioner, also travel from site to site and do an amazing job of providing care and building strong relationships with the women. One key to the success of a program like this is building trust in the community we serve, and that is all about the people in the program.

CF: The “perinatal” part of the program’s name defines the stage of the motherhood journey you focus on, but I’m curious what happens after a woman gives birth?

DM: That’s a good thing to bring up. There is a high-risk period for substance use relapses after giving birth. Having a newborn can be stressful for any mother, and some of our moms are in especially stressful environments. Their new baby may also experience more fussiness than most infants because of neonatal abstinence syndrome.

Our program has a strong care management component, right from when a woman enters it until after they’re six weeks postpartum. We never brush off our hands and say we’re done just because mother and child left the hospital. This is a life-long journey. Among other things, we work with AHN’s Center of Excellence for Opioid Use Disorder to assist women following delivery and assure a strong handoff to excellent, continuing care beyond our program.

CF: What hopes do you have for the future of the program?

DM: Mainly, I hope for the support to continue reaching out to more communities. I see these women and babies and I just want to do whatever we can do to help them. We know we can’t help everybody — sometimes a woman just can’t take that step. But if we keep our doors open and maintain a welcoming, nonjudgmental atmosphere, and put as many great resources as possible in reach, we give more women the best possible chance to deliver a healthy baby and maintain their own health as well.