Opiate Use During Pregnancy in Ohio: By the Numbers
88 babies per 10,000 live births suffer from Neonatal Abstinence Syndrome
4,200 pregnant women admitted to drug treatment from 2004-11
5,100 hospitalizations resulting from NAS from 2004-11
$70 million in health care costs associated with NAS
92 deaths from unintentional drug overdoses in 2012 in Butler County
Source: Ohio Department of Health
More babies are being born dependent on illegal drugs each year in Ohio.
Babies suffering from Neonatal Abstinence Syndrome — defined as a group of problems a baby experiences when withdrawing from exposure to narcotics — has increased six-fold from 2004 to 2011, according to the Ohio Department of Health.
The number has risen from 14 per 10,000 live births to now 88 per 10,000 live births.
“It’s an epidemic that’s sorely under-resourced right now,” said Michele Stokes, clinical director of women’s and perioperative services at Mercy Health Fairfield Hospital.
The rise in NAS is attributed to an increasing use of heroin and abuse of prescription pill opiates by expectant mothers.
The number of women being treated for drug use during pregnancy has almost doubled in the past eight years with over 4,200 pregnant women admitted to treatment between 2004 and 2011, according to ODH. Opioids surpassed marijuana and cocaine, and were listed as the top drug of choice from 2010 onward.
While babies are born dependent on the drugs, they are not addicted, according to hospital officials. Hospitals use specialized care, including tapering doses of methadone, to help the baby safely get through withdrawal.
At Mercy Health Fairfield Hospital — making about 2,150 deliveries a year — less than 1 percent of those births include opiate abuse, and less than 5 percent include any drug or alcohol substance, Stokes said.
To prepare for a baby born dependent on drugs, the hospital screens the urine of expectant mothers for the presence of drugs. The drug screening — not done as a punitive measure — is completed up to three times before the baby arrives.
If the urine tests positive for drugs, the baby is assessed after birth, every three to four hours, for 21 signs of drug withdrawal — using the Finnegan Neonatal Abstinence Score Sheet — including excessive high-pitched crying, sweating, tremors, diarrhea, poor sleep after feeding and poor feeding.
“These babies are inconsolable and difficult to calm down,” Stokes said.
While a normal healthy baby usually has a score of zero, a newborn meeting the criteria for NAS will have a score of eight or more for multiple assessments in a row, Stokes said.
She said babies with NAS stay in the hospital up to three weeks after birth in order to safely go through medically-assisted treatment using methadone. Other common conditions associated with NAS include respiratory complications, low birth weight, feeding difficulties and seizures.
In Ohio, approximately 5,100 hospitalizations resulted from NAS in inpatient and outpatient settings between 2004 and 2011, according to ODH. Treatment of those babies amounted to over $70 million in charges and nearly 19,000 days in Ohio’s hospitals in 2011.
“It’s very time and labor intensive,” Stokes said.
At Atrium Medical Center in Middletown, a number of babies are treated for NAS each year, said Christie Gray, administrative director at Atrium’s Family Birth Center. She said it’s becoming more common, but no recent data was available.
Gray said along with tapering methadone doses, other interventions include holding, swaddling and rocking the baby; special caloried formula to get more calories into baby; and diaper barrier creams.
“We often find staff has to spend a lot of time rocking and soothing the baby,” said Marty Cole, nurse manager at Atrium’s Family Birth Center.
Middletown Health Commissioner Jackie Phillips said she sees quite a few woman who are pregnant and addicted to heroin.
“We have high rates of heroin and opiate addiction, and of course, they’re not going to discriminate from female to male to pregnant female,” Phillips said.
In fact on May 5, Middletown police arrested a woman, Amanda Gibbs, who was 8 months pregnant for drug abuse. The woman was holding a syringe, which she tried to stuff down the back of her pants, and had suboxone — an opiate derivative used to help people get off heroin — in her bra.
Middletown police Sgt. Andy Warrick said it was very likely Gibbs has used heroin while she was pregnant. “It throws up red flags that she’s still possibly using that and taking suboxone,” he said. “It’s detrimental to the unborn baby.”
Warrick said police have actually arrested individuals for narcotics “and two days later they’re giving birth.”
“We have courts that can try to order help, however, typically those individuals get out and they go back to the same drug scene,” he said.
Phillips said any kind of drug or alcohol abuse could result in the newborn having neurological issues, organ development problems, low birth weight and premature birth.
“Any kind of addiction or drug taken will compromise the fetus,” Phillips said. “The baby will go through any kind of withdrawal the mother would go through if she had long-term use.”
The nonprofit Sojourner Recovery Services in Hamilton has provided residential drug treatment to women for 30 years, including those pregnant. The agency’s Perinatal Program also aids women through a prevention and education effort geared toward women of child-bearing age and their partners.
Kendra Hall, perinatal director at Sojourner, said she goes into schools, hospitals, prenatal clinics and social service agencies to spread the program’s message of the negative effects of drugs and alcohol during pregnancy.
Hall said she will meet with women one-on-one to determine the need for treatment or referral to another agency for issues such as domestic violence or lack of housing.
Pregnant women entering the residential program can stay up to 90 days after the birth, and Hall can work with the women for up to one year after the birth.
“They just want support,” Hall said. “This is a disease and it’s taking over her ability to make healthy choices.”
In fiscal year 2013, the perinatal program reached 266 women. Hall said she met one-on-one with 90 of those women and 25 were put on her caseload.
A former client at Sojourner, Dusty Howell, 33, of Butler County, is a recovering heroin addict. She spent four months in the residential treatment program in 2007, and delivered a drug-free baby during her stay.
Howell said she grew up with two drug-addicted parents, and also dealt with physical and sexual abuse. At 18, Howell was pregnant with her first child and abusing crystal meth and cocaine.
By 23, she was shooting heroin.
“I overdosed while pregnant and didn’t know I was pregnant,” Howell said of her second child. “I went into rehab and was clean until he was a year.”
Howell said she’s had multiple relapses over the years. Her last major relapse into heroin, at age 26, led her to UC Health’s then-University Hospital to seek help. She stayed there a month to detox before entering the residential program at Sojourner and giving birth to her third child.
“It was terrifying,” Howell said. “I knew how hard it was for me to withdrawal and it broke my heart to have a little boy lying there going through this because I caused it.”
Howell said she keeps in regular contact with Hall, whom she says has been her No. 1 support system over the years. Howell said she’s been drug-free since 2007; save for one relapse to alcohol in 2012.
“I’m just as susceptible as anyone to turn that corner,” Howell said. “The big picture for me is I will die if I relapse.”
Howell said the Sojourner program has taught her personal responsibility, how to build healthy habits and establish boundaries, and how to adjust to drug-free life.
“There’s hope out there for everybody, but they’ve got to want it,” Howell said. “If you’re told to do something and you’re not ready, it’s not going to work.”
Several legislative efforts underway in the 130th General Assembly relate to the abuse of opiates by pregnant women.
Earlier this month, House Bill 529 was introduced to the Ohio House as a way to protect unborn children from drug abuse. Local representatives Margy Conditt (R-Liberty Twp.) and Wes Retherford (R-Hamilton) introduced the bill to add the charge of “corrupting another with drugs” if someone supplies illegal narcotics to a pregnant woman.
As well, Substitute House Bill 315, now sitting in Ohio Senate, would require maternity units, newborn care nurseries and maternity homes to report the number of babies diagnosed as opioid dependent to the state health department.
Rep. Mike Turner (R-Dayton) since March has been hosting forums with leaders from the Greater Dayton Area Hospital Association to assess the needs of the community and possible future legislation on the issue.
The state has also been participating in the Maternal Opiate Medical Support (MOMS) project since August 2013 when Gov. John Kasich announced a $4.2 million plan to support interventions and prenatal treatments for 300 women and babies over the next three years.
Staff Writer Lot Tan contributed to this report.
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