In 2015, the number of babies who went through methadone-aided withdrawal in the Birthing Center at Springfield Regional Medical Center doubled to 14.
Through the end of August this year, that number stood at six — five of whom were in treatment to lower their dependency when they gave birth.
The changes are largely the result of a cooperative venture launched in June 2015 by McKinley Hall, the Birthing Center, Rocking Horse Center and Clark County Family and Children’s Services.
Formed at a time when the heroin epidemic was surging and births of drug-exposed and addicted babies was on the rise, Partnerships for Health Pregnancy adopted an innovative plan advanced by Dr. Narinder Saini.
Saini, the medical director at McKinley Hall, began to move addicted and pregnant women from heroin to the withdrawal drug Subutex, then wean them off that for a period of four to six months while local obstetricians stabilized the women’s health and provided prenatal care.
The goal, with the support of all participants, was to have the mothers and babies drug-free at the time of delivery, then move the mothers to the relapse-prevention drug Vivitrol for their continued recovery.
McKinley Hall reports that three mothers successfully completed the program last year, eight have done so thus far in 2016, and six more are currently in treatment.
The program is making a difference for the babies and mothers, Dr. Shawn Osterholt, medical director of the Springfield Regional Birthing Center. He gives Saini strong marks, particularly for his tireless efforts to coordinate and individualize patient care.
“The partnership is what’s so good,” Osterholt said. “If he wants to call me, he’s going to. If I’ve got a problem with a patient, I can call him.”
Since Osterholt and others in his practice also see patients at the Rocking Horse Center, the benefits of the cooperation cut a wider path.
Saini is “the only doctor in the state we know of that’s doing this,” McKinley Hall CEO Wendy Doolittle said. “I’m surprised it hasn’t caught on.”
When pregnancy isn’t involved, Osterholt said an adult patient withdrawing from heroin “is going to be miserable for several days, but, as a rule, you’re not going to die of acute heroin withdrawal.”
But the involvement of a developing baby and then newborn requires another course of action.
From a medical standpoint, the long term effects of what’s called Neonatal Abstinence Syndrome remain unknown, Osterholt said.
There’s no good science,” he said.
The possibilities include threats to the child’s neurological development, including development of autism and attention deficit and hyperactivity disorder.
A threat of stillbirth is known.
The health pregnancies program monitors expectant mothers’ care throughout their pregnancies.
“I generally will call their (obstetricians) monthly, make sure they’re showing up for their prenatal care,” McKinley Hall therapist Kathy Maddy said.
At the same time, she shares information with her clients’ permission about their progress in their treatment at McKinley Hall that might be helpful to obstetricians and/or the Birthing Center in preparation for delivery.
Another key for the partnership’s success is that by the time McKinley Hall approached the hospital, the birthing center had been gearing up to respond to the emerging crisis.
“We have been blessed because of the physicians that run our nursery,” said Shirley Wise, clinical educator for the birthing center.
The neonatologists all are associated with Dayton’s Children’s Hospital and connected with the Ohio Perinatal Quality Consortium, a group of Ohio’s six children’s hospitals. As the consortium has shaped its response to the heroin crisis, Springfield Regional has reshaped its practices and procedures.
Because heroin use “truly crosses all social lines” and “there’s no classic, standard patient,” Osterholt said the hospital began screening all pregnant women for drug use.
“People out there know how to clean their urine,” Wise said, “(but) we still have a tool to (identify) a baby who’s going to be born addicted.”
The nursing staff also was trained in the use of the Finnegan Score, a technique for assessing the severity of infant withdrawal based on symptoms.
During withdrawal, Wise said babies have the same essential symptoms as adults.
“They will start yawning and sneezing,” she said. “And then they have trouble eating. They will have (gastrointestinal) upsets: They spit up a lot, which we would call vomiting in an adult. And they have real frequent stools and they cry a lot.”
Like people with hangovers, she said, withdrawing babies prefer quiet settings with low light.
Attending nurses have learned new ways to swaddle and soothe, adjust formulas to minimize stomach upsets, and have undergone training in “nurturing the mother, nurturing the child,” she said.
The birthing center staff has treated babies in withdrawal for as long as six weeks, Wise said. Saini estimated the average stay for a child is 10 to 12 days at a cost upward of $10,000 a day.
The changes required to respond to the epidemic — which include weekly calls to the Department of Child and Family Services to look out for the welfare of addicted babies — have transformed and continue to alter the culture of the birthing center.
“We weren’t doing this five years ago. All of us are learning,” Osterholt said. “And sometimes it’s difficult.”
His mantra through the process has been, “Don’t be judgmental.”
“You don’t know how patients get addicted, what their home life is like,” Osterholt said.
Along with training, Wise said regular contact with the mothers has opened birthing center nurses and staff members to the realities of the mothers’ lives and eased the sense of unease that existed at first.
Although the work at times “can be heartrending,” Wise said, “at the same time, it can be very satisfying to make a difference.”
All parties involved say the success to date is due in large part to the level of cooperation among all those caring for the women and infants.
McKinley Hall’s Doolittle describes Springfield as being “leaps and bounds above other communities” on that front.
Another plus for Springfield is the presence of a single birthing site, Wise said, something that prevents addicts from playing one facility against another.
One institutional challenge for Clark County as the crisis has emerged is the lack of an inpatient detox facility. But the bigger immediate challenge is finding ways to move mothers into treatment.
“What’s alarming to me,” Maddy said, “is the people that don’t make it (to McKinley Hall) any time during their pregnancies.”
She particularly worries about women who might try to withdraw on their own late in pregnancy and go into early labor.
A study done by the Clark County Drug Death Review Committee indicated that half of all people who died of heroin overdoses “never set foot in McKinley Hall,” Doolittle said.
Since then McKinley Hall has tried to visit all of those who have survived non-lethal overdoses and get them into treatment. Of 51 contacted, she said, 45 percent at least started treatment.
Whatever that number is for using mothers, Wise said finding them is crucial.
“We’ve got to get the word out there to let people know the program is working,” she said.