Clinic to provide prenatal care for pregnant addicts

September 19, 1990|By Jonathan Bor

The Francis Scott Key Medical Center plans to open a novel clinic aimed at getting pregnant addicts off drugs and preventing injury to their babies -- in some cases, by admitting the women for extended stays through their pregnancy, delivery and postpartum period.

Aside from treating their addiction, Key's Center for Addiction and Pregnancy will offer women a host of prenatal and psychiatric services under the same roof in an attempt to fight the tendency of many addicts to ignore their health -- and their babies' -- until they go into labor.

Doctors hope that by getting women off drugs and into prenatal care, they will reduce the high incidence of serious complications among the babies.

"We're going to try to get them to take a different view of their family, of themselves," Maryland Health Secretary Adele A. Wilzack said at a news briefing yesterday. "We're going to say, 'Enough. Stop doing this to yourself and your family, and here are the tools.' "

The Center for Addiction and Pregnancy is due to occupy one floor of the Mason F. Lord Center, a hospital-based nursing home that is being moved to another building. The program is expected to open in January.

The state Department of Health and Mental Hygiene will issue an $800,000 grant to Francis Scott Key -- not quite a third of the projected $2.5 million in first-year expenses. Most of the remaining amount will come from Medicaid and insurance payments. The program will have room for 150 patients a year, most of them outpatients. It will have 16 beds for inpatients -- women deemed likely to sink back into patterns of drug and alcohol abuse, homelessness and poor health care if they were left to come and go as outpatients.

Baltimore has more than 500 pregnant addicts enrolled in drug- and alcohol-treatment programs, although a far greater number are believed to be going through pregnancy without any treatment, according to state officials.

Dr. George Huggins, who will direct the center, said the clinic's concept emerged from the long-standing frustration of seeing pregnant addicts enter and leave detoxification and methadone programs, but fail to make good on prenatal appointments set up for them.

"They'd be given referrals for prenatal appointments, but we wouldn't see them till it was 4 o'clock and they'd be in premature labor," Dr.Huggins said.

Women who abuse alcohol and drugs during their pregnancy substantially increase their risk of delivering a child with mental retardation, fetal alcohol syndrome, physical abnormalities and symptoms of drug withdrawal. Many of the babies are extremely small, which itself makes the children prone to learning disabilities and other problems.

Research shows babies born to addicted mothers also die of SIDS -- sudden infant death syndrome -- more often than other babies.

Many are infected with the acquired immune deficiency syndrome or hepatitis virus while they are still in the womb. Physicians with the program say it is the only one in the United States offering women addiction services as well as family planning, psychiatric care and job counseling under one roof. Other programs, they say, offer some of these services -- or all of them, but in several locations.

Dr. Preston M. Gazaway III, the clinic's director of obstetrics, said he expects many of the program's patients will first arrive at the hospital with a medical emergency -- such as preterm labor, prenatal complications or a suicide attempt. Then, they will be referred to the program for further treatment throughout their pregnancy.

Heroin addicts may be placed on methadone maintenance, while counseling will be used to keep addicts off cocaine. Some of the inpatients will stay at the center for a week or two after they deliver -- the period when postpartum depression can send a recovering addict back into active drug-taking or drinking.

While the program appears to be without precedent, Francis Scott Key officials said it grew out of a 2 1/2 -year-old program in which obstetricians delivered prenatal care to pregnant heroin addicts when they showed up to get methadone. This was a radical departure from the usual reliance on addicts to go voluntarily to a prenatal clinic.

During those 2 1/2 years, babies born to 42 expectant addicts who received prenatal care at the methadone clinic spent an average of one day in the neonatal intensive care unit. During the same time, babies born to 52 cocaine-abusing patients who received little or no prenatal care spent an average of 21 days in the intensive care unit.

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