In the United States, close to 5 million people are dependent on opioids. According to the Center for Disease Control and Prevention, whilst women are more likely to be prescribed prescription pain relievers, they are also more prone than men to become dependent on them.
The National Institute on Drug Abuse presents staggering figures: every 25 minutes, a baby suffering from opioid withdrawal is born. Opioids cross the placenta increasing the possibility of poor fetal growth, preterm birth, birth defects, as well as neonatal abstinence syndrome (NAS).
Aware of the epidemic proportions of the situation, Charles from Dreaming of Baby speaks with Amy Sedgwick, Director of Clinical Operations at Mountainside Drug Addiction Treatment Center on treatment options and support for pregnant women with opioid dependency, and women wishing to conceive after opioid addiction.
Charles: We have with us today Amy Sedgwick, Director of Clinical Operations at Mountainside drug addiction treatment center to discuss with us Opioid use recovery and pregnancy. Thank you for joining us today Amy. Can you give our readers a little bit of background about yourself and your experience in dealing with this important subject?
Amy Sedgwick Director, Clinical Operations: Sure. I hold a license in treating addictive disorders in the state of CT and have a Masters in Clinical Counseling. I have been working in addictions for more than 15 years and find this subject to be of particular interest and value.
Having a baby is one of life’s most amazing blessings and struggling with addiction is such a complex issue. However, addiction is treatable and children are a gift!
Charles: That is excellent. For the benefit of our readers I would like to explore a few potential scenarios so that we can learn from your experience as well as provide some sound advice to anyone struggling with addiction. Will this be okay with you?
Amy Sedgwick Director, Clinical Operations: Absolutely.
Charles: A current opioid user is seeking to start a family, she is clear on her intent to go through the necessary treatment but is having a hard time getting off prescription opioids on her own. What will her journey to recovery look like? What are the first steps?
Amy Sedgwick Director, Clinical Operations: The first step is connecting with a treatment provider and following the clinical and medical recommendations. Following through with the recommendations and being open and honest about intentions and personal goals is important. Detoxification and continued treatment to remain abstinent and address the underlying issues would support long term recovery goals, as well as parenting goals.
Charles: What is the normal process of detoxification?
Amy Sedgwick Director, Clinical Operations: It starts with being evaluated by a medical team and using withdrawal scales as a tool to identify the course of medical intervention. Detox from opiates is typically 5-7 days but can certainly be longer given the nature of the person and substance use. Medications are used to treat withdrawal symptoms while clinical interventions are used to motivate and begin the healing process.
‘Detoxification and continued treatment to remain abstinent and address the underlying issues would support long term recovery goals, as well as parenting goals.’
Charles: All things being relatively normal, (as I appreciate it will vary from one person to another), what period do you recommend from detoxification to starting to work towards getting pregnant and what support measures do you recommend to assist in avoiding relapse?
Amy Sedgwick Director, Clinical Operations: I would recommend that one speaks with their doctor to evaluate that during active use, one did not become deficient in any areas. Medical clearance, beginning prenatal vitamins while following all other medical recommendations to begin with. Also, one should evaluate if their family/home life is stable enough to support a healthy pregnancy. Treatment which may consist of psychotherapy and/or psychoeducation would help support one to remain focused on recovery goals, develop coping skills and work toward relapse prevention.
Charles: Many mothers to be struggling with opiate addiction may also face the stigma of addiction, this is especially true in cases when the drug use is out in the open so to speak; a partner may also have serious concerns. What do you recommend in terms of bringing family and partners into the recovery process; how important is it that they gain a better understanding of the condition to help support the mother to be?
Amy Sedgwick Director, Clinical Operations: It is crucial! Reducing stigma also reduces shame and guilt. Shame and guilt are barriers for recovery. The more family and loved ones are involved, the more they can support and ensure a safe recovery environment. Mountainside Treatment Center offers family therapy, family wellness orientation and educational workshops as a means of offering various types of tools and necessary interventions.
Charles: Excellent, so it would be safe to say that support plays a very important role both from a professional stand point as well as from family and partners. I will now move towards another scenario:
A current opioid user is pregnant, she has decided to keep the child and is seeking professional help to get clean. What would be the steps she would need to go through? How does treatment differ for someone that is already pregnant?
Amy Sedgwick Director, Clinical Operations: It would be recommended that she seek medical attention and be honest and open to recommendations. Working with a team of professionals who specialize in this and considering the best form of maintenance therapy, whether it be Methadone or Buprenorphine treatment. These are considered standard forms of care for pregnant women addicted to opiates.
Charles: You mentioned above that guilt and shame can be barriers to success; what approach is taken to help the mother to be work through potential feelings of guilt associated with the risk to the unborn bundle of joy?
Amy Sedgwick Director, Clinical Operations: CBT known as Cognitive behavioral therapy is a useful model of clinical work that allows one to become in tune with thoughts as they pertain to feelings and behaviors. This type of therapy is useful in reframing thoughts and overcoming feelings of guilt.
Charles: What, if any, advice would you give a mother to be in this situation? I would like to get a better understanding of the type of maintenance therapy, will the maintenance therapy be for the entire duration of the pregnancy or is it a weaning off process? In effect, is there light at the end of the tunnel when getting treated early on in the pregnancy?
Amy Sedgwick Director, Clinical Operations: The maintenance therapy would be for the duration of the pregnancy for Mom, the baby would need prolonged hospitalization to treat symptoms related to receiving the maintenance meds in utero. Once Mom felt stable after delivery, she could develop a plan with her medical and clinical team for tapering off. This plan is often most successful when completed over a longer period of time, versus attempting to taper rapidly.
Charles: So, in effect the addiction is maintained throughout the pregnancy as opposed to detoxification? Is this one of the major ways in which treatment whilst pregnant differs?
Amy Sedgwick Director, Clinical Operations: Yes, this is one of the major ways in which treatment differs. The mom will be safely maintained on maintenance medication.
Charles: I want to ask a practical question you may be able to answer; I know it will differ from one insurance to another but is the kind of treatment required generally covered by standard health insurance policies or would it fall outside the cover and be considered elective?
Amy Sedgwick Director, Clinical Operations: In my experience, it would be covered.
Charles: Excellent thank you for your time and dedication to helping us inform mother and fathers to be about this important subject. I would like to run another scenario; it actually follows on from our current discussion:
A current opioid user has given birth; the newborn has been treated for Neonatal Abstinence Syndrome (NAS). The mother is full of guilt and her husband has made it clear that she needs to get clean. With all the responsibilities facing her she is unable to enter a live-in rehab facility; what are her options?
Amy Sedgwick Director, Clinical Operations: She should consult with her clinical team and her insurance carrier to find the best options. The more support wrapped around her and around the baby, would allow for more healing and the recovery process to take place. While mom enters treatment, whether it be inpatient or outpatient, she will need help caring for the baby in her absence. Reducing her shame and guilt would allow her to begin forgiving herself and identifying achievable recovery goals. Family therapy would be beneficial so that the husband/partner can learn about addiction and gain tools to help his partner. Even though an inpatient facility may be preferred, they are many options.
Charles: Do you also recommend any support groups?
Amy Sedgwick Director, Clinical Operations: Yes, 12-step support groups are a wonderful and useful tool: constant support from a non-judgmental and relatable group of peers.
‘Reducing her shame and guilt would allow the mom to begin forgiving herself and identifying achievable recovery goals.’
Charles: Excellent, I have one last question for you today. If she were to be admitted to an inpatient facility how long is the average stay before shifting to outpatient support?
Amy Sedgwick Director, Clinical Operations: The most common length of stay is 30 days, however there are longer term options available and also shorter length of stay programs.
Charles: I would like to thank you on behalf of our readers as well as note that the subject is vast and we will be tackling more specific subjects in the future as it is difficult to delve too deeply in one session. Before we close off this interview, is there anything you would like to share with our readers that you believe to be of paramount importance in dealing with opioid addiction and pregnancy?
Amy Sedgwick Director, Clinical Operations: Thank you. It was my pleasure to participate in this today. I would want to end on a final note of saying this: Recovery happens every day! Recovery is possible. If one feels that they are struggling, I strongly encourage them to connect with a provider. Be open and honest and don’t be ashamed. Coming forth and entering a program of recovery can allow for one to reach life’s goals… including raising a healthy and happy family!
Charles: Thank you very much for your sage advice, recovery is indeed possible and I would like to thank you for all the work you do in ensuring that recovery is possible!