Pregnant and Addicted to Opioids? You might want to read this.
Introducing The Positive Direction Model: Opioid Use and Pregnancy, 1st Edition
Davina Moss-King, PhD wrote The Positive Direction Model for pregnant women diagnosed with opioid use disorder. The book focuses on women and their newborns, highlighting the opioid epidemic’s impact on the infant’s health when the mother used or is using opioids. The book introduces the Positive Direction Model and the Positive Direction Matrix, the four components of concern for the medical professional; along with the model’s six components of comprehensive care for a healthy pregnancy and safe delivery. The Positive Direction Model: Opioid Use & Pregnancy is a helpful educational reference for women during their pregnancy. The six chapters focus on explaining the ‘positive model’ that decreases fears, enhances knowledge, and promotes healthy decisions with self-confidence.
The purpose of the ‘Positive Direction Model’ is to decrease fears and encourage women to experience pre-natal care early in the pregnancy with the proper supports. It is with high hopes that these supports continue postpartum, decreasing insurance costs and lessening emergency room visits for mom and baby.
The initial low price, and the eventual high cost.
According to the Center for Disease Control (2017) opioid abuse increased dramatically over the last decade. The staggeringly significant numbers of overdoses, compiled with more and more women misusing and abusing drugs, stem from the overhaul of unnecessary prescriptions for opioids and other narcotic/habit-forming drugs (CDC, 2014). The increase in prescription opioids affects men and women in various life areas, but the most significant concern has been the use and abuse of opioids during pregnancy.
From 2000 through 2012, the incidence of maternal opiate use during pregnancy increased from 1.19 to 5.77 per 1,000 hospital live births each year. Every 25 minutes an infant is born with chronic opioid withdraw also known as neonatal abstinence syndrome.
(Source – National Institute on Drug Abuse, 2017)
The cost to insurance companies coupled by the dangers mothers and infants face are causing a national concern. The length of treatment for the NAS infant, the pharmaceutical regimens administered to treat the baby, render a wider scope of problems not only for the adults involved, but the newborns as well.
Fear of being judged
Treating opioid use disorder during pregnancy can be complex, requiring an extensive amount of assistance and knowledge from providers and of the pregnant mother. As the opioid epidemic rises in numbers of affected families, fewer and fewer women with substance use disorders seek medical treatment prior to pregnancy. This behavior continues during pregnancy. And the cycle continues.
Prenatal care may be difficult because of social, psychological and environmental influences. Fear of being judged or uncertain of the medical professionals involved with their prenatal care may also affect a mother’s decision to seek medical assistance.
In order to provide optimal care for this population of patients, health care providers must treat these women in a caring, non-judgmental way.
Opening up the lines of communication
There is, however one consistent problem that will make the difference in the woman’s pregnancy and in her unborn child’s first stages of life in utero, and that is the communication of all providers. Communication between providers is imperative. Each provider should understand any changes in the mother’s health. A multidisciplinary approach, which is the six comprehensive components of the ‘Positive Direction Model,’ can be implemented as the woman and her baby are the main focus in the prenatal care. The positive direction model is designed to decrease the infant’s hospital stay for Neonatal Abstinence Syndrome (NAS) and decrease state and federal costs for an infant immediately following birth and beyond.
The Positive Direction Model: Opioid Use & Pregnancy will help the mother begin to understand the four components of concern that Obstetricians and Gynecologists have for pregnant women with opioid use disorder, called The Positive Direction Matrix:
- Neonatal Abstinence Syndrome,
- Mental Health,
- Substance use Disorder, and
The struggle is real
Neonatal Abstinence Syndrome is the diagnosis for opioid exposed infants after birth with withdrawal symptoms and physical discomfort the infant displays after birth due to opioid exposure. By reading the book, the mother will learn about NAS and the pharmacology used to assist the infant while he or she is experiencing withdraw to opioids. Withdrawal for an infant can include: diarrhea, temperature fluctuation, intense high pitch crying, and the inability to become comfortable. She will learn the importance of mental stability pre and postpartum.
The possibility of postpartum depression is surreal a the intervention of a mental health specialist may become necessary to maintain stability. Mothers need only to take the necessary prescribed medications during pregnancy.
This is extremely important, along with implementing relapse prevention strategies during prenatal and postpartum. Lastly, family is a concern; the woman will need to identify her support circle during the pregnancy and if there is a safe environment for daily activities and appropriate self-care.
Pregnancy can be overwhelming; however, combining pregnancy with an opioid use disorder can increase anxiety and fear that the mother will not seek prenatal care or providers to prescribe appropriate medication for a safe pregnancy. The Positive Direction Model is implemented for the pregnant mother to have a safe pregnancy and a safe delivery. The model’s six comprehensive component s guided by:
- A navigator to include the following providers for the moms prenatal and postnatal care;
- Opioid Maintenance Therapy Provider (Assisted Medication Provider) is used to prescribe medication that is safe for the mother and the infant during pregnancy and delivery;
- Mental Health Specialist / Behavioral Health Specialist;
- Substance Use Disorder Counselor;
- Obstetrician / Gynecologist; and finally
- A pediatrician.
Evidence of proper interventions using the Positive Direction Model’s Matrix as six comprehensive components include infants born safely with limited symptoms of Neonatal Abstinence Syndrome, spending less time in the hospital’s Neonatal Intensive Care Unit. The average stay in the Neonatal Intensive Care Unit for an infant born exposed to opioids is 60 days. With the implementation of The Positive Direction Model, infants stayed in the hospital averaging only five days. Mothers were empowered knowing that they were a positive contributor to their prenatal care and the healthy delivery of their infant.
To order The Positive Direction Model: Opioid Use & Pregnancy, 1st edition (March 15, 2017; ISBN: 978-1-5246-6905-8) contact Dr. Moss-King via e-mail [email protected] or contact 716-961-3434.
Center for Disease Control and Prevention (2013, 2017). National Center on Birth Defects and Developmental Disabilities. Key findings: Maternal Treatment with opioid analegesics and risk for birth defects: Atlanta, GA.
Moss-King (2017). The Positive Direction Model: Opioid Use & Pregnancy, 1st Edition. Bloomington, IN
National Institute on Drug Abuse (2017). Neonatal Abstinence Syndrome.
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