First Steps Together helps moms maintain opioid recovery

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PITTSFIELD — Dr. Kathleen Sheridan was at a national gynecology convention in 2017 when she shared with colleagues the rate of babies born in Berkshire County who are exposed to opioids.

The room went quiet.

That rate, 82 per 1,000 babies born at Berkshire Health Systems, was about four times the state average and 10 times the national average, said Sheridan, an OB-GYN with BHS.

That number has since grabbed the attention of state and community leaders, agencies and health care providers, who have joined forces to ensure that these babies and their moms are getting the services and care they need to thrive.

"We come together to talk about what the issues are that these moms are dealing with," said Sheridan, who co-chairs the county's Perinatal Opioid Collaborative with Jennifer Barnaby. "Our goal is really to just help these moms maintain their recovery and be ready to provide a great home for their babies."

Representatives from a variety of agencies regularly meet to discuss how best to address opioid-exposed families. To do that, the collaborative has formed a network of support services.

One of the more recent additions is First Steps Together, a grant-funded program that works with pregnant and postpartum women who have opioid use disorder. The program, which is a part of the Center for Human Development in Springfield, is based at an office on North Street. There, women and their babies are paired with family recovery support specialists with lived addiction experience, participate in parenting and recovery groups, meet with a staff clinician and are linked to any social services they might need.

"Being a mom is hard enough. Never mind being a mom, especially a first-time mom, and trying to juggle your recovery and all of this stuff," said Barnaby, the program's director. "It's a lot. Our job is to help in any way that we can."

On Thursday, several moms participated in a parenting group at the office. One room at the office was filled with diapers — free to members of the program. Clothing and books related to motherhood also were there for the taking.

One 22-year-old woman spent several hours at the First Steps office with her nearly 2-month-old baby. The woman, who asked not to be named, has been in recovery for two years and comes to play groups and parenting groups once a week. Her family recovery support specialist picks her up in Adams to take her to the office.

"We text all day," she said of the relationship she has formed with her recovery coach. "I really like that if you need help with diapers, and wipes, they do that. They've helped me with anything I've ever needed."

Barnaby has enrolled 35 parents in First Steps Together since March 1 and expects to hit 50 by the end of the year.

Given a recovery coach

When they walk in the door — they typically are referred by their OB-GYN or the Department of Children and Families — Barnaby works to assess each woman's needs. After making those determinations, the mother is assigned one of three family recovery support specialists, also known as recovery coaches, and they work out their goals for the program.

"If a woman is enrolled in our program and she is pregnant, the first thing we would do, depending on where the referral came from, is see if she's interested in medicated-assisted treatment," Barnaby said. "What does she need? Does she have housing? Does she need food stamps? Does she have WIC? Is this her first pregnancy?"

The mothers are given a binder full of recovery resources, a calendar and space for contact information, DCF documents, and other information related to their pregnancy and childbirth.

While they work with their coaches on achieving their goals, they fill out the binder. Many of them later will present it to the DCF, if they have involvement with the agency. If a pregnant woman tests positive for opioids before delivery, even if it's from medication-assisted treatment, the DCF is notified, Barnaby said. First Steps doesn't drug test, but most mothers voluntarily tell their coaches where they are in recovery.

"When they do hand it over, they feel extremely proud because they know the social workers and DCF are getting this binder," she said.

Nonjudgmental environment

Many pregnant women or new mothers who are in recovery will not seek treatment or participate in classes available to the general public, Barnaby said, because they are afraid of the stigma around addiction. The chances of a woman actively using heroin or in recovery attending a Lamaze class, for example, are "slim to none."

First Steps brings the classes to them in an environment that is nonjudgmental so they feel comfortable sharing their concerns and questions.

Dr. Claudia Gold, the First Steps clinician, specializes in infant-parent mental health.

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Mothers and their babies enrolled in First Steps meet with her, in sessions that last about 50 minutes, to talk about how their relationship is growing and any concerns they might have.

Her office is in no way clinical. Instead, blankets and baby toys cover the floor, and Gold will spend the appointment playing with and observing moms and their infants.

"This is exactly what I love to do; to work with vulnerable parent-infant pairs and set them on a healthy path from the beginning," Gold said. "If you want to change unhealthy patterns that have been going on for generations, this is the time to do it."

Gold talks to mothers in recovery about concerns that arise from stigma but aren't based in fact.

For example, some mothers are fearful to partake in medication-assisted treatment like Suboxone or methadone while they're pregnant or nursing.

"The science is, it's better for them — it's certainly better for the fetus — being on medication-assisted treatment rather than going off the opioids [completely]," Gold said. "We're in transition in terms of how parents in recovery are viewed."

The same goes for breastfeeding.

"Moms who breastfeed their babies are less likely to need medication," Sheridan said. "It's really good for the baby."

Additional training

With the increased number of babies exposed to opioids, all OB-GYNs and midwives at Berkshire Health Systems have gone through additional training to screen expecting mothers for opioid use disorder, and on treatments and resources available to them, Sheridan said.

"The prenatal care doesn't differ dramatically. It's still a pregnant lady, and were still taking care of her and her baby," Sheridan said. "But they have different concerns."

While every woman is worried about the pain of childbirth, mothers in recovery might worry that their tolerance to pain medication will be an issue, or they might not feel safe taking pain medication at all, she said.

Their providers will go into detail with families about what their options are and how they will keep the mothers safe during delivery.

Other than that, the goal of the health care providers is to limit the number of babies with neonatal abstinence syndrome who require medication, usually methadone, for their opioid withdrawal syndrome, Sheridan said.

Some of the biggest things to reduce that need is helping mothers who are on medication-assisted treatment to quit smoking and encouraging them to breastfeed, she said. It's also helpful for newborns suffering from withdrawal symptoms to room with their mother, instead of in a hospital nursery, she said.

For babies with neonatal abstinence syndrome, withdrawal from opioids in the biggest concern. Doctors and nurses will screen all of the babies for four days for symptoms of withdrawal, which can include being tremulous and difficult to console, Sheridan said.

But unlike babies born with fetal alcohol syndrome, who are at risk of developmental issues and delays, opioids have not been shown to have the same lifelong effects, Sheridan said.

"With these babies, that transition period is important, but were not seeing the issues and delays," she said.

Berkshire Health Systems delivers about 880 babies a year. In 2018, the rate of babies born with neonatal abstinence syndrome decreased from 82 per 1,000 to 49 per 1,000, according to Sheridan. But it's too soon to call the decline a downward trend, Gold said.

Currently, there are 25 moms in recovery receiving prenatal care with Berkshire Health Systems, and 31 mothers in recovery have delivered in the past 12 months, according to Sheridan.

One of the most important things to ensure that these women have successful pregnancies and provide healthy environments for their babies is to make them feel safe and unjudged so they are willing to use the services available to them.

"I had a patient tell me she was in line at the methadone clinic with her big pregnant belly and the other women in line were giving her dirty looks," Sheridan said. "The answer is, your baby is going to be fine."

Haven Orecchio-Egresitz can be reached at horecchio@berkshireeagle.com, @HavenEagle on Twitter and 413-770-6977.


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