Pubdate: Mon, 28 Jan 2018
Source: Boston Globe (MA)
Copyright: 2018 Globe Newspaper Company
Author: Felice J. Freyer


Dajia Brown cares for Brooklyn at their Somerville home. She credits a
Boston Medical Center program for her progress.

Last June, Dajia Brown embarked on a dangerous phase of life - so
dangerous that many in her situation do not survive.

It started when she gave birth to her daughter, Brooklyn, several
months after entering treatment for addiction to fentanyl pills. The
postpartum period, a tough time for many women, can be particularly
challenging for women with opioid use disorder, putting them at high
risk of relapse and overdose.

In Massachusetts, according to the state's analysis of overdose
deaths, nearly four in 10 deaths among women who gave birth between
2011 and 2015 were caused by opioid overdoses, compared with two in 10
among women who did not give birth.

Against the odds, Brown has stayed sober and is raising a healthy baby
in Somerville, an outcome she attributes to the help she received at a
Boston Medical Center clinic established for women like her and their
children. But that clinic started only in July, and such programs are
few and far between. More commonly, advocates say, new mothers
struggling with addiction get little attention.

"We take intensive care of women during pregnancy. Postpartum, we drop
them like a hot potato," said Daisy J. Goodman, a clinical assistant
professor at the Dartmouth Institute for Health Policy and Clinical

In some states, Medicaid benefits for women can end two months after
childbirth. Even in Massachusetts, where coverage continues under a
generous Medicaid program, new mothers who have struggled with
addiction often confront a hostile world alone.

When pregnant, many women stop using drugs to protect the child
growing within them, and usually can find programs that help sustain
them in treatment, such as Boston Medical Center's Project RESPECT.

With women motivated and supported, rates of overdose-related deaths
drop during the second and third trimesters.

Then the baby comes.

And women new to recovery, who still need treatment and support, have
an often-fussy infant calling on them around the clock, while
temptations to resume drug use lurk around every corner.

But they don't find as much help as they did when pregnant - and the
overdose death rate soars among women six months to a year after
giving birth.

"Now we're realizing the easiest part is when you're still pregnant,"
said Dr. Kelley A. Saia, Project RESPECT director. "Postpartum, all
your resources tend to fall apart."

That's why in July Boston Medical Center launched its SOFAR Clinic
(Support Our Families through Addiction and Recovery) for patients
leaving Project RESPECT.

It currently treats about 60 mother-infant pairs, including Dajia
Brown and her daughter.

With pediatricians, internists, social workers, and psychotherapists,
the clinic can take care of both mother and baby on the same day. The
clinic provides Brown with buprenorphine, a drug that controls her
cravings and prevents overdoses, and it coordinates treatment for a
heart disorder she developed during her pregnancy.

Brown is often stricken with anxiety but says she can always reach
someone at the clinic for help. As a result, the 24-year-old said, she
is in her longest period of sobriety - 17 months - since she started
using drugs at age 15. She's motivated by her grief over losing
custody of her first child and her commitment to keeping Brooklyn.
"She's been a miracle to me," Brown said.

New mothers in recovery from addiction confront extraordinary
obstacles, according to people who care for them. Most are allowed to
take their babies home but live in fear of losing them as the
Department of Children and Families watches over their shoulder.

Many have experienced trauma and, according to Massachusetts data, 70
percent have a serious mental illness. Postpartum depression is common.

Often lacking cars or helpful partners, these young mothers are
expected to traipse, newborn in tow, from one appointment to another -
to obtain their addiction medications, to treat their own health
issues, and to take the baby to the pediatrician.

"The expectations we have for these mothers are so incredibly
unreasonable," said Dr. Eileen M. Costello, a pediatrician and medical
director of the SOFAR clinic. "No wonder they can't maintain their

To make matters worse, some return to households where partners,
parents, or siblings are using drugs or prone to violence.

Others don't even have a household to return to.

Dajia Brown and Brooklyn are one of about 60 mother-infant pairs being
treated at Boston Medical Center.

In Massachusetts, according to health department data, 60 percent of
mothers with opioid use disorder are homeless; they end up shuttling
among shelters and friends' couches.

"One baby - 5 months old - had lived in four different places in her
life," Costello said.

And yet the first year is a critical time for the child, probably as
important as the months in the uterus, said Dr. Zev Schuman-Olivier, a
psychiatrist and medical director for addictions at the Cambridge
Health Alliance.

"This is when their personality is going to be developed, their
ability to relate to others . . .'' he said.

"The prognosis of these kids is largely dependent on whether their
mothers can maintain their recovery."

Schuman-Olivier has been developing technology to provide addiction
treatment remotely, which he believes will be especially useful for
postpartum women.

Patients use their smartphones to meet daily, by videoconference, with
"mobile recovery coaches," who are trained to work remotely counseling
people with addiction.

Patients also have a device that dispenses their daily dose of
buprenorphine, only after the coach provides a code that opens it.
While the coach watches, the patient dissolves the medication under
her tongue.

Schuman-Olivier has tested the program with young adults and now plans
to launch a treatment program for new mothers, probably starting in
the spring.

The treatment of postpartum women with addiction "reflects how we as a
society think about women," said Goodman, of the Dartmouth Institute.

The pregnant woman gets care for the infant's sake, she said. "After
the baby is born, we're very focused on the baby. The mother - it's as
if we're saying 'you're not so important anymore,' " she said.

But nothing could be further from the truth, in Goodman's view: The
child's well-being depends on the mother's. "The goal," she said, "is
a healthy mother and healthy baby together."
- ---
MAP posted-by: Matt