Local health officials are attempting to fight the stigma associated with a longstanding problem in Bartholomew County that some local healthcare providers say may be getting more prevalent — the use of methamphetamine, opioids, tobacco and other substances during pregnancy — which can have severe consequences for babies.
The full scope of the problem of drug use and pregnancy is hard to capture as these women may be less likely to get routine prenatal care and tend to have unstable housing and change communities a lot. But some local health officials say that they have been seeing what appears to be an increase in the number of pregnant patients struggling with addiction since the COVID-19 pandemic hit last year.
“I don’t have numbers to support it, it’s just sort of what I feel like I see in my practice,” said Dr. Rachel Reed, an obstetrician and gynecologist at OB/GYN Associates of Columbus. “I don’t know how much of it really is more substance use or if it’s more that we’re finally identifying the patients. Maybe these numbers have always been where they are but we’re finally able to offer them help and treatment.”
High demand for treatment
Health experts across the country have feared that the desperation and stress caused by the pandemic — including extended isolation due to staying at home and being laid off from jobs — could deepen the nation’s drug crisis. And the pandemic made the search for drug rehab harder due to shutdowns, scaled back operations or delayed openings.
But once local facilities opened their doors, they often saw high demand, including among pregnant women and new mothers.
Last month, officials at the Fresh Start Recovery Center, an addiction recovery center for pregnant women and new mothers in downtown Columbus, reported higher-than-expected demand, serving 112 women during its first year of operation, including three women who gave birth while in treatment, said program director Hillary England in a previous interview. The most common substance the women sought help for was methamphetamine.
CRH’s Treatment and Support Center (TASC), which opened its doors in July 2019, provides a range of outpatient treatments for substance abuse disorders including medication-assisted treatment in certain cases. TASC was getting about a referral each week for a pregnant woman as of summer 2020, said TASC Medical Director Dr. Kevin Terrell in a previous interview. About five or six women gave birth while in treatment at TASC during the center’s first year.
But it’s not just illegal substances.
In some ways, tobacco use among pregnant women in Bartholomew County is “a much bigger problem” and also is dangerous in pregnancy, local officials said.
Overall, about 15% of women — a little more than 1 in 7 — who give birth at CRH smoke, said Kylee Jones, tobacco awareness coordinator for Healthy Communities. Reed estimates that about 30% of her pregnant patients use tobacco or vape, compared to an estimated less than 5% who use illegal substances.
“That’s a really high number when we’re talking about substance use disorder,” Reed said. “…It’s just that tobacco is legal, so people look at that differently.”
Risks for babies
The use of illicit drugs — including methamphetamine and opioids — and tobacco is associated with a range of health consequences for the baby, including an increased risk of pre-term labor and pre-term delivery, Reed said. Most substances that the mother uses can pass easily through the placenta and reach the fetus.
“Pre-maturity is probably the biggest thing we see, and that has a lot of long-term effects depending on how early the baby was born,” Reed said.
A lot of babies that are affected by their mother’s substance abuse are born after about 30 to 34 weeks of pregnancy, which increases the risk for immature lung development and reactive airway disease for several years, as well as developmental and motor delays, Reed said. A normal pregnancy lasts about 40 weeks.
“Those babies, typically for the long term, probably do OK,” Reed said. “…Potentially, they catch up (in some ways) by the time they get to school age, especially if they have the opportunity for some early interventions.”
But babies born earlier than that — three to four months early — often experience “significant developmental delays,” cerebral palsy and other conditions that “very much change the quality of life for that person for their entire lives,” Reed said.
Besides an elevated risk of being born premature, many babies exposed to illicit drugs go through withdrawal after being born, or neonatal abstinence syndrome, particularly if the mother was using methamphetamine, opioids or nicotine products.
The withdrawal can last as long as six months and the baby can experience seizures, trembling, breathing problems, vomiting, fever, among other symptoms, according to the March of Dimes. In 2014, more than 500 babies in Indiana experienced neonatal abstinence syndrome, according to the Indiana University School of Medicine.
“We expect babies exposed especially to chronic opioid use to experience a pretty decent withdrawal, which can be a really rough experience for the baby and parents,” Reed said.
One of the major barriers to treatment for these women is the stigma associated with drug use in pregnancy, local officials said.
Reed, who described the stigma as “so difficult,” said pregnant women who are struggling with substance use disorder don’t want to be using drugs and often feel ashamed that they are. It often takes multiple doctor’s visits before the patient is willing to open up, disclose drug problems and ask for help.
Officials at Healthy Communities and CRH say they have heard new mothers who have struggled with substance use disorder talk about the difficulty of the stigma during listening sessions, said Patty Pigman, co-coordinator of the Infant Mortality Prevention Action Team at Healthy Communities at Healthy Communities.
“It’s really hard for moms who are worried about the stigma piece,” Pigman said. “So I’m going to be judged if I put my hand up and say that I need help, which we’ve heard from a lot of moms. …They’ve said that’s kind of stopped them from getting help. They had opportunities. They could have said something to their doctor, but they were really worried about how they would be perceived.”
“They just want to be the best mom they can,” Pigman added. “That doesn’t change because they’re using meth or whatever substance.”