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MATERNAL
MORTALITY

Mommies Program

Benefits Mothers with Substance Use

Disorders and their Babies in Bexar County

By Jaime Estrada, MD

ccording to a new study published in the journal Pedi- After a few days in jail for petty theft, she found that she was 16
A atrics (1), in this country every 15 minutes an infant is weeks pregnant. Upon release, she was sent to the Restoration Cen-

ter, operated by the Center for Health Care Services, and joined the
born with withdrawal symptoms from having been ex-
posed to opioids in the womb. Infants experiencing Mommies Program.
opioid withdrawal are irritable, can have feeding and breathing prob- The program, which requires near-daily participation for about
lems and are more likely to be born with low birthweight. three months, is free to any pregnant woman diagnosed with a sub-
From 2004 to 2014, the number of U.S. infants diagnosed with stance use problem. The women work with a clinician to manage
opioid withdrawal symptoms, known as neonatal abstinence syn- their opioid addictions with methadone or buprenorphine and re-
drome (NAS), increased 433 percent, from 1.5 to 8.0 per 1,000 hos- ceive free transportation, child care and parenting classes. In spite
pital births. The increase was even more pronounced in state of participating in the program, Yolanda experienced break-through
Medicaid programs – rising from 2.8 to 14.4 per 1,000 hospital withdrawal symptoms and continued using heroin until one month
births. Medicaid covered more than 80 percent of NAS births na- before delivery.
tionwide in 2014. Medicaid covered 48 percent of all births in 2014. Yolanda went into labor at 30 weeks. She remembers how cold
Adjusting for inflation, total hospital costs for NAS births that and unkind hospital staff was when informed of her drug use. The
were covered by Medicaid increased from $65.4 million in 2004 to attitude of staff can be critical in helping drug addicted mothers
$462 million in 2014 in this study. NAS has been linked to the use get past the shame and form strong attachments to their babies. “It
of both illicit opioids such as heroin and legal opioids like Vicodin. takes time and training to help clinicians understand the impact of
There were 324 babies diagnosed with NAS born in Bexar stigma and bias,” says Lisa Ramirez, Coordinator of the Texas De-
County in 2015, the most recent year state statistics are available. partment of State Health Services Women’s Substance Use Disor-
Bexar has consistently ranked first in NAS cases since the state ders Services. Yolanda's daughter was born 10 weeks premature and
began recording the data in 2009 with 300 to 400 babies born with weighed only 3 pounds. She was diagnosed with NAS and hospital-
NAS per year. The total number of NAS cases in Texas increased ized for seven weeks for supportive care.
by 75 percent from 2010 to 2015. Yolanda requested to participate in the Kangaroo Mother Care
Yolanda Aldana first became dependent upon Vicodin prescribed (KMC) Study which had been mentioned at a class in the Mommies
for persistent pain after an epidural procedure she received when program. Dr. Lisa Cleveland, Principal Investigator of the KMC
delivering her second child. She felt this medication relieved her Study, leader of the Bexar County Neonatal Abstinence Syndrome
anxiety and depression after the child was hospitalized for seizures Collaborative and faculty at the UT Health San Antonio School of
and brain surgery for Chiari malformation. Nursing, came to the hospital to assist Yolanda in doing KMC and
Once her prescriptions ran out, she began snorting heroin, which helped educate the staff on its use with infants experiencing opioid
was cheaper and lasted longer. She quickly became addicted. The ele- withdrawal.
mentary school reported her to CPS when her daughter arrived wear- The infant, dressed in only a diaper, is cradled against the mother’s
ing the same dress several days in a row. She failed a drug test. CPS bare chest, allowing the baby to smell her mother and hear her
developed a safety plan. Her mother and sister agreed to care for the mother’s heartbeat. This also makes on-demand breastfeeding more
children while Yolanda attended rehabilitation. This didn’t work, and likely. This continuous skin-to-skin contact between mom and baby
she left her mother’s home after two days and continued to use. provides comfort to both. Yolanda recalls feeling “like being in a

26 San Antonio Medicine • July 2018