She started using drugs at 16. After moving around the country and trying to quit several times, she came back to St. Louis four years later, hoping for a fresh start.
After a few months, B. started using again. She has borderline personality disorder, a mental illness that makes it difficult to regulate emotions. She used drugs, mostly illegal opioids, to deal with the mental pain.
Last winter, she had a chest cold and went to an urgent care center to get a steroid shot. After an exam, a nurse called her over and explained she couldn’t get the medicine, because it might harm her baby. Soon, she would need help with prenatal care and overcoming her addiction, the kind of treatment a Washington University clinic provides.
“I just didn’t really know if it was true,” B. recalled of the nurse’s message. “It was really scary.”
An ultrasound proved she was 14 weeks pregnant. And she was still using heroin and fentanyl.
“I knew I wanted to be a mom, for sure, but I didn’t know how I was going to be able to do that when I was in the middle of a really dark time for myself,” she said.
St. Louis Public Radio is not using B.’s name to protect her privacy. She knew she needed help to save her baby and herself. But addiction treatment for pregnant women can be hard to find, and that shortage puts mothers and their unborn children at risk. B. was lucky. With the help of her mom, she found the CARE clinic, which treats pregnant women with substance use disorder.
“I think that it was maybe about 15 minutes later, I got a call back from the doctor I still see now,” she said.
‘A one-stop shop’
That doctor was Jeannie Kelly, a high-risk obstetrician and the medical director of the Clinic for Acceptance Recovery and Empowerment. The clinic opened last year with the goal of serving patients who, like B., need opioid-addiction treatment alongside care for high-risk pregnancies.
“We wanted to create a one-stop shop for these patients,” Kelly said, adding that pregnancy creates an opportunity to reach women who might never go to the doctor otherwise.
“They’re seeking medical attention potentially for the first time in years,” she said.
The CARE clinic is open half a day each week and is open to all people, insured or not. In addition to prenatal care from high-risk obstetricians, pregnant people receive mental health treatment from psychiatrists and addiction counselors.
Most of the patients receive medication-based treatment such as methadone and buprenorphine, which helps prevent cravings and reduce withdrawal symptoms. That medicine makes it less likely for women to use illegal opioids and overdose or get infected with a disease such as HIV or hepatitis.
There’s a shortage of addiction treatment for all people who need help, Kelly said.
But that need is especially acute for moms. Fearing complications, many doctors drop their patients when they find out they’re pregnant.
“We’ve seen patients that had established relationships with doctors and providers who treat these disorders who tell them, ‘We’re no longer able to take care of you,'” Kelly said.
That’s especially dangerous for mothers in recovery, who often need constant medication to help keep their bodies from craving opioids. If a doctor drops a patient because she’s pregnant, it could put her at risk of using again, if only to keep withdrawal symptoms away.
Babies born to mothers who use opioids are at risk for a host of developmental and physical problems. Opioid use during pregnancy can even cause miscarriages or stillbirths. And many newborn babies will suffer from neonatal abstinence syndrome, in which they’re born physically dependent on opioids and need to be weaned off them after they’re born.
A judgment-free place
Patients with addiction are more likely to be dealing with other problems that keep them from going to the doctor and staying on track, Kelly said.
That’s where Brittaney Vaughn comes in. She’s a nurse navigator at Barnes-Jewish Hospital and one of the first people patients meet at the clinic.
“I’m literally there for them all day. Some patients text me, some call me; I talk to each patient at least once a week,” Vaughn said.
Patients at the CARE clinic know her as a person who helps them with whatever they need. That could be helping them find housing, transportation or getting insurance approval for their medicine.
Pregnant women with addiction have so much to be dealing with, Vaughn said. Helping women with chronic problems helps them focus on their recovery and keep their babies safe.
Sometimes she’ll just listen.
“They’re so used to being judged, they think that everybody is judging them,” Vaughn said. “When they notice we’re there to support them, that makes a world of difference. You can tell when someone trusts you.”
As B.’s nurse, Vaughn knew her patient was worried about what the neonatal intensive care unit was going to be like in case her baby needed to be treated there.
“It was really scary. I had never been in a NICU; I had never seen little tiny babies in little boxes,” B. said.
After B. went to Vaughn with her concerns, Vaughn arranged a tour of the NICU.
“It’s a lot better to have an idea instead of just going to it blind,” she said.
Clinic workers also prepare patients for what might happen to them and their babies immediately after they give birth. Nearly half of the 60 babies born at the CARE clinic have needed to visit the NICU to be treated for neonatal abstinence syndrome or other complications, Kelly said.
The clinic also prepares parents for the legal struggles that may come after giving birth. When babies are born with drugs — legal or illicit — in their system, state welfare workers investigate and decide whether the child is safe living with their parent.
Keeping the two together is one of the clinic’s highest priorities, Kelly said.
“I think a lot of the conversation before on maternal use and misuse has centered on what to do with this baby who's withdrawing,” she said, “The conversation should be, 'What do we do with the mom and baby [pair]?'”
That support is especially important in the weeks after birth, when the risk of relapse is the highest. Psychiatrists and counselors continue to see them for months or years after they give birth.
“I think for anyone who has had a baby, whether you have any mental health issues … knows that postpartum is a really hard time. There’s lots of hormone changes; you’re suddenly taking 100% care of this incredibly helpless being. It’s a hard time for everybody,” Kelly said.
‘It’s amazing what women can do’
But pregnancy is a powerful motivator.
“It’s amazing what women can do while they’re pregnant for their children,” Kelly said. “We have moms who come in and completely are in recovery, with no relapses during pregnancy, but are unable to maintain that outside of pregnancy. I think in those patients, their disease is so severe and their situation is so hard that all they can do is just be in recovery for pregnancy.”
The time B.’s been pregnant is the longest she’s been in recovery since she started using drugs, she said. When she got the news at the urgent care clinic that day, everything changed.
“I don’t just live for myself anymore, and that’s something that’s tremendously helped me, once I realized there’s more to live for than my own happiness,” she said. “Now I’m living to give her a life, a different life than what I had."
B. gave birth to her baby girl a few weeks ago. They're both very tired, she said, but they’re doing fine.
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