Encouraging and empowering

January 6, 2020

Addiction treatment in Southern Indiana NEST program helps new mothers overcome substance use disorder

In a perfect world, all babies would be born healthy and to mothers who are fully prepared and able to care for them. However, the incidence of opiate addiction in Southern Indiana among pregnant women has redefined how health care professionals think about substance use and its complexities.

In response to this rising issue, community health care organizations have formed Southern Indiana NEST (Nurture, Encourage, Stabilize, Treat), a comprehensive program to help expectant families dealing with substance use disorder and their babies who may experience effects of substance use. Southern Indiana NEST is a collaboration of Clark Memorial Health, Norton Healthcare, Total Health Care for Women, and Southern Indiana Comprehensive Treatment Center.

Dr. Arthur Boerner, OB-GYN with Total Health Care for Women in Jeffersonville, has both personal and professional experience with addiction that makes him realistic in how he cares for pregnant women with substance use disorder. He is a proponent of medication-assisted addiction treatment through a prescribed regimen of buprenorphine (also known as Subutex), which helps reduce cravings for opiates and prevents withdrawal symptoms.

To put it uncompromisingly, “When we envisioned [the NEST] program, we wanted the babies to be born alive,” Dr. Boerner says. Prescribing expectant moms buprenorphine reduces the likelihood that they will seek street drugs and overdose, which is the ultimate threat to their unborn babies. Furthermore, Dr. Boerner says that when infants are born under buprenorphine treatment, they will likely still need care in Clark Memorial’s NICU but will spend much less time there than if their moms have been using drugs such as heroin.

Dr. Boerner works alongside Clark Memorial Health social worker Janice Martin to help expectant moms have the courage to consider a recovery program. Expectant mothers with substance use disorder often feel a tremendous amount of shame and guilt as a result of their addiction, Martin says. Many of them come from childhoods where addiction was the norm, not the exception, which means they carry internalized confusion and anger. “We’re trying to guide them to a safe way of managing whatever battles they are having,” Martin says. “It’s a lot of pieces that go into getting them to accept help.”

Expectant mothers in the NEST program have access to both in-patient and intensive outpatient therapy options through Clark Memorial’s Behavioral Health unit, as well as to two women who serve as “addiction doulas” who share both truth and comfort, Dr. Boerner says. “Many of our addicted patients say, ‘This is the first time that people are taking this seriously and not judging us,’” he adds.

In treating moms with substance use disorder, health care professionals have to treat the entire family, dealing with any co-dependencies that exist. In order to do this, professionals have to look at addiction in a new way, which Dr. Boerner says is the final piece in the NEST program. Everyone from OB-GYNs to physicians’ assistants to pediatricians has to take a different perspective when it comes to addiction education.

Looking at addiction as a disease, rather than a willful choice, is part of that perspective, as is recognizing that expectant moms who are taking drugs are primarily doing so to avoid withdrawal sickness, which can include nausea, vomiting, muscle aches, sweating, and diarrhea. Dr. Boerner says his patients say to him, “I don’t want to hurt my baby.” Like other health care professionals who specialize in addiction, he strives to reduce harm to both mothers and babies and takes a realistic approach in that goal.