Multidisciplinary Approach Makes Difference for SUD Patients Who Are Pregnant

For patients who are pregnant, additional barriers to substance use disorder (SUD) treatment can be difficult to navigate. A multidisciplinary team of practitioners is crucial for eliminating stigma, building patients’ trust, and fostering a healthy environment for recovery.

Earlier this month at the Cape Cod Symposium on Addictive Disorders, Brooke Schaefer, director of perinatal substance use disorder programs for Community Health Network in Pendleton, Indiana, discussed best practices for treating SUD in pregnancy.

Schaefer recently spoke with Addiction Professional about the additional challenges SUD patients who are pregnant face, the practitioners who comprise a multidisciplinary treatment team for pregnant SUD patients, and ways in which providers can be better advocates for pregnant patients in recovery.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: What are the biggest challenges that patients face when seeking treatment for substance use disorders during pregnancy?

Brooke Schaefer: The biggest challenges that they run into are simply access to care and trust in the system. There are so many opportunities in the treatment of mothers where their children become a bargaining chip against them—their children could be removed, they’re terrified of DCS [Department of Child Services] involvement, and they don’t trust the system itself. There are many points within trying to access care, where the stigmas are so negative for their outcomes, that I think that’s their biggest challenge when they’re trying to find the right place to go—finding a place that understands all the different aspects of treatment of substance use. It’s not just the OB/GYN part, the medical aspect, it’s not just the therapy part, it’s not just the medications--it’s all of them together and the ramifications of each decision. They’re on a time limit. If their goal is to parent this baby, they must find some stability by the time their baby is born so there isn’t time to just come to it at your own speed. It really does become like there is a countdown to when some sort of stability has to be achieved.

AP: What are the benefits of working with a multidisciplinary team during SUD treatment in pregnancy? Who are the members of that team, and what are their respective roles?

BS: We have a therapist on staff with our program. She specializes in working with mothers with substance use disorders. The groups she runs are much more focused on things that come up in parenthood. … They’re oriented to people who are trying to parent and maintain recovery at the same time, and the stressors and different emotions that have to be worked through in that process. We also have nursing as part of our team. We have inpatient and outpatient care. Those nurses are trained in trauma-informed care. They’re trained in how to care for these patients in a way that’s consistent but also medically cutting edge because you need to be both.

You can’t just be medically cutting edge without explaining to the patient why and how this is different than maybe their last time, and all the different aspects that need to be consistent as well as being consistent in that trauma-informed care. If a mother says to us, “I don’t want to be monitored right now, I don’t want to be in the straps that you use to monitor the baby, it’s too confining,” then we’re going to work around that to make sure that she’s getting what she needs without feeling trapped or cornered in that whole process. We have a peer recovery coach in our program who is also a graduate of our program, so she is really able to go with these patients in their journey and talk to them about being exactly where they are: “I’ve dealt with this. I’ve dealt with that. I’ve seen this.” No 2 people’s journey is exactly the same, but I see an immediate change in people’s faces when they meet her. They’re like, “Oh, OK, you guys are legit. This is the real thing.”

We work with social workers who understand the system well and can explain to these moms, “In Indiana, our DCS department is going to most likely handle this like this. Here’s what we can do proactively to make the best possible outcomes.” ... We have very transparent conversations with patients. If DCS does have to be involved, we make sure that we make those phone calls on speaker with the patient in the room so there are no surprises. We’re all in that team together so patients know what’s coming.

And then, of course, we also have medical providers. I, myself, am a nurse practitioner, but we also have another full-time nurse practitioner alongside OB/GYNs who were embedded within the offices that we serve. We had OB/GYNs who had an interest in treating substance use disorders, and we work directly with them so the pain control that these patients are going to get at delivery is going to be very consistent, it’s going to be very good. We don’t have to torture these patients for them to have their delivery. Delivery is often a painful experience, and we want to make sure we control that pain so the doctors are able to give these patients good, sound medical advice that’s also based in a trauma-informed care model.

AP: How can practitioners be better advocates for improving the care of pregnant patients with SUD and helping to maybe build that trust factor?

BS: Being as transparent as possible has been a huge aspect of the care for these patients. ... One of the first things they want to talk about is what happens to this baby at delivery? What will be the legal ramifications of any of this? What does this mean for my other children? That’s usually the very first conversation that they want to have, but I let them guide that. If that’s not the first conversation, we start where they want to start. But it’s really making sure that we have consistent messaging, that we are telling them exactly what we know, that we’re being super transparent with them, while also making it clear to them that our expectation is not perfection. … From the medical community, we have expected perfection from these patients and then been repeatedly disappointed when they don’t achieve it. That’s not realistic. ... That’s a horrible expectation of any patient, let alone someone who is struggling with the ups and downs of finding recovery.

That’s where we. As a medical community, we need to say yes way more than we do. We need to figure it out. Being open-minded to that concept of—and I see this a lot in the recovery community now, but I’m starting to see it more in the wider medical community—this concept of, “We’re going to work through this with you, we’re not just going to force you to follow one algorithm, and if you’re not perfect, you’re out.” That’s not what we’re going for, and that’s not an expectation that’s reasonable in any way.

AP: Was there anything else that you wanted to mention?

BS: It’s really important that we think about the leading cause of death in the postpartum period. From the time a baby is born until the baby is 1 year old, the leading cause of death is overdose. We hear a lot in the medical community about women dying from other causes—hemorrhage and embolisms and all these things—but the leading cause of death is overdose. So, the OB/GYN world pretending like substance use disorder is not their problem is completely wrong. It is their problem. We need to treat it. We need to be part of that team.

That’s where a multi-disciplinary team makes a huge difference in these patients’ outcomes by addressing all aspects of their recovery and providing those lifesaving measures. These are all preventable deaths, and so we really need to be part of that journey. That’s what we’re doing at Choice, and that’s what we’re hoping to see more of throughout the country.

Reference

Schaefer B. Not making it someone else’s problem: Treating SUD in pregnancy. Presented at Cape Cod Symposium on Addictive Disorders; September 7-10, 2023; Hyannis, Massachusetts.