A growing number of babies in Vermont have been documented at birth as experiencing exposure to opiate drugs in the womb, according to analysis from the Vermont Department of Health.
Nearly 40 infants per 1,000 births to Vermont residents at in-state hospitals were exposed to opioids in 2012, state numbers show. The rate has been growing over recent years, and is among the worst in the nation. Health officials note the vast majority of births involving opiates are to women who are in treatment for their dependency, so physicians and health policy makers see that level of treatment access as encouraging.
At Fletcher Allen Health Care in Burlington, Vermont's largest hospital, neonatologist Dr. Anne Johnston has seen the increase first-hand. Johnston said more awareness of the issue today partially explains the increase in reported births involving drug exposure. "In those years [in the early 2000s] where we saw one or ten or fifteen, there were many other women with opiate dependence and opiate addiction who were pregnant who were too ashamed and too afraid to come forward," Johnston told New England Cable News.
Skyler Browder, a 24-year-old mother of a 3-month-old boy named Cree, told NECN she sought help for opiate dependence during pregnancy. "I didn't want to put, continue to put, harmful substances; more harmful substances in my body," Browder remembered. "So Methadone was the safest option for me, I felt."
Browder said she used to abuse powerful prescription painkillers. Her first exposure, she said, was a legitimate dose after surgery in high school. Later, she had become hooked on opiates, she said, and found that heroin was a cheaper and more accessible alternative to illicit pills. Browder said rehab helped her get clean before she became pregnant with Cree, but during her pregnancy, she relapsed.
Browder said her care providers prescribed Methadone as a heroin replacement for the mom, but that medication was reaching the new life growing inside her. "He was very small when he was born," Browder said of Cree. "For me, it was a feeling of-- I almost failed before I started. You feel guilty. Is he small because I was on this medication? If I wasn't on this, would everything have been fine?"
Little Cree had to spend two and a half weeks in the Neonatal Intensive Care Unit at Fletcher Allen. There, doctors gave Cree tiny doses of Methadone for a short while to wean him off the medicine he had become dependent on. Dr. Anne Johnston said opiate withdrawal symptoms typical of NAS, Neonatal Abstinence Syndrome, include shaking, high-pitched crying, diarrhea, increased muscle tone, and others. Many of these symptoms, Johnston noted, are also present with other conditions, so nurses and doctors conduct tests to assess the severity of NAS.
Johnston said the vast majority of Vermont's pregnant opiate users are on a treatment regimen such as Methadone replacement combined with counseling, not actively abusing pills or heroin, and that leads to better outcomes. "If you don't focus on the health of the mother, you're not really going to count on great health from the baby," Johnston said.
Johnston said at Fletcher Allen, many newborns showing withdrawal symptoms go home after a week. That's less than half the time Johnston said is typical of other institutions, and is due to a comprehensive approach to therapy, she added. Not all babies with NAS require Methadone, Johnston noted. About a fifth of kids exposed to opiates in the womb who are born at Fletcher Allen receive medication therapy for withdrawal, Johnston said.
Some parents are given Methadone to provide their newborns at home, which "steps them down" in a pre-planned way, Johnston explained. The practice, she acknowledged, is divisive in her field. "Some people can't believe that. They say, "What? These families have substance abuse problems-- you're going to give them Methadone to take home and give to babies?'" Johnston said. "In actual fact, it's such a small amount and they're on the medication that they need. We have not found any cases of women taking their babies' Methadone."
Social workers, nurses, and non-profits in the community team up to make sure moms and their little ones come back to the hospital every few weeks, Johnston said, ensuring an ongoing relationship. "To keep the babies safe, we have to keep the mothers engaged in treatment," she added.
In this data brief, the Vermont Health Department said Vermont's coding practices on hospital discharges, provider awareness of the issue, and improved accessibility of treatment all are plausible explanations for the disparity between Vermont's rate and the U.S. average rate. The U.S. average appeared on paper to be a seventh of Vermont's number in 2009, according to the brief.
"We're very open [in Vermont] to having those conversations," said Dr. Marjorie Meyer, an obstetrician at Fletcher Allen Health Care. "If you have states that are taking very punitive approaches, women are not going to come into the office and say, 'Look, I need help with this problem, I want to do the best for myself and my baby and can you help me?' Here, we're like, 'Absolutely-- we'll do whatever we can to get you into treatment.'"
Meyer told NECN that Fletcher Allen's care providers recognize addiction as a chronic, relapsing disease, and added that the health care system as a whole needs a lot of empathy to break through the shame and stigma associated with addiction to help pregnant addicts and their babies. "This is a medical condition. It really could happen to anybody," Meyer said. "A success would be for the moms to successfully be able to parent their child. And I realize that's uncomfortable for a lot of people, as well."
Meyer said another challenge of treating opiate-dependent pregnant women is that a very large number of them also smoke tobacco. She said cigarettes, as do opiates, increase the risk of small babies, pre-term births, and bleeding.
Skyler Browder said she is still on Methadone, is in a 12-step program, and is getting help on her path to recovery from the non-profit Lund. The Burlington organization works to reduce child abuse, prevent teen pregnancy, encourage loving families and secure homes for children, and treat women for substance abuse and mental health issues. Lund also counsels pregnant women and teens, teaches parenting skills, and supports new moms battling addiction. For more on Lund, visit its website.
"We just want to be the best moms we can and provide for our children and our families, too," Browder said of mothers battling addiction.
Browder said she would like to go to college, and work toward becoming a teacher. As for Cree, Browder said he's happy and developing well. She expects she'll be honest with him when he's older about her past drug use, hoping he stays clear of the substances that consumed her. "If I don't stay sober, I don't have anything," Browder said. "I don't get to be the mom I want to be."
The Vermont Department of Health has a webpage dedicated to pointing Vermonters to help for opioid addiction, explaining Vermont's strategy to address the public health issue, and supplying information on overdose prevention. Click here to visit that page.
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