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Sean Collins, host of the Hear Me Now podcast, recently spoke with three guests about the importance of compassionate care for pregnant women who are struggling with addiction.
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Addiction Recovery Services has a special program for pregnant patients.
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Caregivers are working to destigmatize substance addiction treatment for pregnant patients.
Jennifer Justice was what you would call a “functioning addict” when she became pregnant with her youngest son, now 8. While she regularly used heroin and other opioids, she still owned her own business, parented her older children and maintained a comfortable life.
She didn’t tell her trusted obstetrician about her addiction until she was near the end of her pregnancy, and while he offered her options for drug abuse treatment, she wasn’t ready for that yet. She felt betrayed when he called Child Protective Services right after she delivered and dropped her as a patient. “That just added to my problems and my addiction,” she says.
Justice was one of three guests who recently spoke with Sean Collins, host of the Hear Me Now podcast, about substance use and pregnancy. The other two guests included William Collin Schenk, M.D., an addiction medicine physician and associate program director of the Providence Swedish Addiction Medicine Fellowship, and Kirsten Lavery, R.N., M.S.N. the nurse manager for Addiction Recovery Services at Providence Swedish Medical Center, Ballard Campus.
The stigma surrounding substance abuse during pregnancy
The difficulty Justice had with her caregiver is just one of the situations Addiction Recovery Services is working to address as it treats pregnant individuals who are suffering from substance addiction, Dr. Schenk says.
“People who are using drugs are much more reluctant to engage in the health care system, often related to past traumas that they’ve experienced,” says Dr. Schenk. “So, our No. 1 priority when someone engages with us is to express our gratitude and appreciation for their bravery and courage.”
According to Dr. Schenk, that includes treating the patient as a complex and whole person first, and then fitting addiction treatment into that. At Swedish Health Services and at Providence, the services are gender-inclusive, and their patients might include transgender males and non-binary people. So, they use the pronouns “they/them” and the word “patient” when referring to the pregnant people who seek substance abuse treatment there.
They’re also actively shifting the language they use to reduce the stigma associated with seeking treatment. For example, the word “detox” is sometimes used to refer to the process of withdrawal from the substance, but caregivers at Addiction Recovery Services prefer to call it “withdrawal management.” In the same way, they address the people in their program as “patients,” and not as “addicts.”
“Addiction is very prone to a lot of colloquial terminology that comes with a lot of judgments and feelings,” says Dr. Schenk.
How caregivers help pave the road to recovery
According to Lavery, the nurse manager for Addiction Recovery Services, the treatment program starts with medical stabilization, either medical or prenatal care, and withdrawal management. After a few days, patients transition to the intensive inpatient program.
“This is where they get to participate in group therapy education about recovery principles, birth prep, parenting and lactation classes,” Lavery says. “But this is really where we have the time to work with somebody on planning for transition out of the hospital and addressing parts of their environment that supported substance abuse or substance use. By the time they get here, they’re often coming in with a lot of shame or fear.”
“They get a chance to see that we aren’t offering judgment,” Lavery continues, “but we’re offering compassion and support. About 50% or more of our patients come in with unstable housing situations, and others have young children that have prevented them from seeking treatment because of lack of child care. So, we partner with different community resources. There are six-month residential treatment facilities where pregnant and parenting women can bring young kids. And we can work with anything that’s going on in somebody’s lives, whether it be legal
challenges or even just connecting them to different support services.”
On the withdrawal symptom management side, most patients opt for receiving medication-assisted treatment with buprenorphine or methadone. “That’s because those medicines are far and away the most effective way for entering and maintaining recovery,” says Dr. Schenk. “They significantly reduce the risk of relapse and overdose, and they’re strongly recommended by about every medical society out there.”
Hope for the future
While recovering from opioid addiction and other kinds of addiction is one of the hardest things a person can undertake, there are people doing it every day. Dr. Schenk says that now that he is a parent, he can see just how difficult it is to do that job, plus be in recovery.
“So many people are able to make it happen,” he says. “There’s hope for so many of them. They’re not giving up — they’re still trying to take care of themselves and their child.”
Contributing caregivers
William Collin Schenk, M.D., is an addiction medicine physician and associate program director of the Providence Swedish Addiction Medicine Fellowship.
Kirsten Lavery, R.N., M.S.N., is the nurse manager for Addiction Recovery Services at Providence Swedish Medical Center, Ballard Campus.
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