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Pregnant patients who use substances may come into hospitals feeling wary or anxious, fearing judgment and discrimination — if they come at all.
In one instance, a mother battling an addiction to heroin sought care at Dartmouth Hitchcock Medical Center to deliver her baby. She said she worried about not receiving the help she needed, but once she arrived, she was given news clothes and blankets, a private room and ample time with her newborn daughter after her birth.
“They didn’t ever treat me like an outcast,” the woman said in an anonymous testimonial. “They didn’t treat me funny. They didn’t treat me like I was a bad person.”
Daisy Goodman constantly sees this fear from patients with substance use disorders. Goodman is an associate professor of obstetrics and gynecology at Dartmouth’s Geisel School of Medicine and a director at the outpatient treatment program Moms in Recovery, where she’s worked with this population of mothers since 2013.
She said patients, before seeking treatment, often have to question about whether they’ll receive evidence-based care or have their choices respected.
“We know substance use conditions are medical conditions that need treatment, just like any other condition somebody might walk into pregnancy with, such as depression or diabetes or hypertension,” Goodman said. “People deserve to have comprehensive care for whatever diagnosis they have.”
Goodman and her team hope to expand care and mitigate stigma through a new inpatient program for mothers experiencing substance use disorder, made possible by a $900,000 award in congressional funds secured by U.S. Senator Jeanne Shaheen.
“We’ve made great strides to fight the substance use disorder crisis, but there’s more we can do to help Granite Staters access the full range of services that they need,” Shaheen said in a statement. “I was proud to secure Congressionally Directed Spending for Dartmouth Health to provide specialized resources to expecting mothers battling substance use disorder so that we can better support them and protect the health and the safety of their newborns.”
The funding will help transform rooms in the center’s birthing pavilion into suites designed to administer treatment medication and manage patients’ safe withdrawal from substance use. A multidisciplinary team, including recovery-trained doulas and behavioral health specialists, will also form to better address patients’ complex needs.
At Dartmouth-Hitchcock, 12.5% of all babies born in 2022 were exposed to substances. The hospital continues to deliver the most babies with prenatal substance exposure out of all New Hampshire hospitals.
In 2019, 9.6% of women nationally reported using tobacco products during pregnancy, 9.5% reported using alcohol and 5.8% used illicit drugs, according to the data from the National Survey on Drug Use and Health.
Goodman said rates of substance use have kept stable in recent years, but providers are increasingly seeing people experience severe effects from non-prescribed drugs. Patients that come to Dartmouth-Hitchcock are now exposed to a “pretty complex mixture” of fentanyl, stimulants or toxic additives, she said.
“What we’ve seen is sort of an increase in the intensity of what withdrawal management looks like for patients, and to the point where it’s not really safe to do it on an outpatient level anymore during pregnancy for somebody who has been exposed to all of this,” Goodman said.
Kate Olivia Stokes, a nurse on the birthing pavilion who works with Goodman, said the center has done a lot of education for staff and providers around substance use and how to treat people in a trauma-informed way. The funding will bolster those efforts.
“[We are] being really respectful and showing compassion for people when they are struggling,” Stokes said.
People come to Dartmouth-Hitchcock from widely different parts of the state, from Concord to Coos County, as well as from neighboring states, like Vermont.
Goodman said she hopes her team will consider how to make the program more accessible and effective for this wide-reaching patient population, “to really build a program that becomes a center of excellence for helping people get into treatment during pregnancy for the initial stages of treatment.”
