Baby and MotherDartmouth-Hitchcock (D-H), the Geisel School of Medicine and the Children’s Hospital at Dartmouth-Hitchcock (CHaD) are in the forefront of offering a one-stop approach to help pregnant women overcome addiction and protect their babies.

Perinatal substance use is a growing population health concern for Vermont and New Hampshire communities served by D-H, and is associated with long-term health problems for women, infants and families.

The Dartmouth-Hitchcock Perinatal Addiction Treatment Program was initiated as a joint venture of the Departments of Obstetrics and Gynecology, Psychiatry, and CHaD in 2013 to improve maternal and neonatal outcomes through a comprehensive program of care for pregnant and postpartum women with substance use disorders.

Opioid use during pregnancy increased five-fold between 2000 and 2009, and a recent report by The Center for Disease Control (CDC) showed that heroin use by women has skyrocketed to alarming rates, mostly impacting young and middle-aged white women in rural areas.

The Dartmouth-Hitchcock Perinatal Addiction Treatment Program offers one of the only programs in New England to offer addiction counseling, treatment, group therapy and perinatal and postnatal care in one clinical setting.

Studies show that women who use drugs but do not receive either assessment or treatment have worse outcomes:  more pre-term deliveries, uterine bleeding, infectious diseases, psychiatric diseases and fetal deaths. In addition, Emergency Department costs for substance-using women who did not receive treatment were 2.5 times higher. Costs related to newborn care also are significantly higher for untreated mothers because of lower birth weights, shorter gestation, and treatment for neonatal abstinence syndrome (NAS).

Research has shown that maternal addiction treatment improves clinical outcomes for their mothers and their babies, as well demonstrating a six-fold savings in the cost of care.

D-H has approximately 1,150 births per year and is a regional referral center for pregnant women with substance use disorders, and for substance-affected newborns. In 2012, 84 newborns were identified as at risk for neonatal abstinence syndrome (NAS).  Of these, 43 were treated with a minimum length of stay of four days. Forty-one were treated for NAS with an average length of stay of 16.62 days for infants born over 35 weeks’ gestation.

What the program offers

Since its inception in 2013 with five participants enrolled, the Perinatal Addiction Treatment Program has continued to expand, currently serving more than 50 pregnant and postpartum women. The program provides comprehensive evidence-based treatment, including psychiatric evaluation, medication-assisted treatment of opioid dependence with buprenorphine, individual addiction counseling, and prenatal and postpartum recovery groups, social supports and basic obstetric care.

Individual and group appointments are held each Wednesday.  In April 2014, the program added the services of a certified nurse-midwife, to provide prenatal care on-site and a social worker to help women access resources. In February 2015, a behavioral health specialist joined the team.

In late 2014, postpartum women were transitioned to a “maintenance” group on Tuesdays to allow the Wednesday prenatal program to expand further.   Patients enter the program during pregnancy and are encouraged to continue through the end of the first postpartum year, after which they may transition to the Dartmouth-Hitchcock adult program.

The Perinatal Addiction Treatment Program is both multidisciplinary and inter-professional, spanning three departments and the inpatient and outpatient environments.  Program components include on-site services at the Dartmouth-Hitchcock Addiction Treatment Program in the River Mill office park in Lebanon, implementation of a standardized program for screening and intervention for perinatal substance use in the Department of Ob/Gyn, and a “rooming-in” program through CHaD for newborns experiencing NAS, which emphasizes non-pharmacologic treatment approaches through partnership with informed and prepared parents.

“At its heart, the Perinatal Addiction Treatment Program is necessarily a multidisciplinary program,” says Dr. Ben Nordstrom, the director of Addiction Services at Dartmouth-Hitchcock. “There is simply no way addiction specialists can take adequate care of the obstetrical and pediatric needs of this population.  By the same token, it is impossible for our colleagues in Obstetrics to meet this population’s needs when it comes to mental health and addiction treatment. The only way this works is by working across departments and across institutions to draw from each other’s strengths and expertise. Thankfully, our colleagues and leadership have proven to be encouraging of this multidisciplinary approach, as this is in keeping with institutional mandates to provide the best care for our patients.”

Overall, perinatal outcomes are positive, including participation in prenatal care, pregnancy weight gain, term gestation, and birth weight, as well as significant reductions in neonatal length of stay and need for NAS treatment compared to the 2012 baseline. Housing instability, co-occurring psychiatric disorders and medical comorbidities, most notably Hepatitis C, are significant challenges to be addressed.

Learn more:

The Perinatal Addiction Treatment Program team continues to expand program services to serve this vital and vulnerable population.

On Tuesday, July 7, NBC Nightly News featured Dartmouth-Hitchcock’s Perinatal Addiction Treatment Program focusing on our success in helping women and their babies overcome heroin addiction. Watch the feature here.

Read more about D-H’s Perinatal Addiction Treatment Program these D-H Today articles: