While a pregnancy announcement is generally a joyous moment, Sara’s* multidisciplinary Care Managers got the baby blues before she could even start dreaming up nursery designs. They were deeply concerned when they learned the 30-year old Medicaid member was a struggling addict and not only expecting, but expecting twins.
Her pregnancy was going to be far from normal. She was a smoker with a history of mental health problems and a worrisome opioid addiction, categorizing her for a high-risk, potentially high-cost pregnancy.
Opioid use can develop into a dangerous addition. Nearly 2 million Americans abused or were dependent on prescription opioids in 20141 and that number continues to rise. An estimated 91 Americans die every day from an opioid overdose2. Her substance use disorder (SUD) with heroin posed dangers to her own health and the twins’ health. SUD can lead to life-threatening physical and mental conditions, driving up healthcare costs.
Because of her substance use disorder, Sara and the babies were at risk for3,4:
Neonatal Opioid Withdrawal Syndrome (NOWS):
Withdrawal symptoms in newborns, including irritability, seizures, vomiting, diarrhea, fever, and poor feeding.
Neural tube defects:
Developmental problems of the fetus’ spine or brain.
Congenital heart defects:
Issues with the development of functionality of the fetus’ heart.
A birth defect where the baby’s intestines grow outside of the body.
Loss of pregnancy after 20 weeks or more.
Birth that occurs before the start of the 37th week of pregnancy.
Sara was already approaching three months into her pregnancy by the time her case was presented to the care managers with Envolve PeopleCareTM. Through our comprehensive Care Management under Behavioral Health services, Sara was connected with Pam* and Daniel*, who focused on tackling her SUD and pregnancy health risks right away. She was going to need substantial support to keep herself and the babies healthy, but it wasn’t an easy start.
It was essential that Sara begin taking prenatal vitamins, but barriers kept her from being able to access them. Pam worked 1:1 with Sara to not only resolve the issues preventing her from receiving those necessary vitamins, but she also connected her with an in-network perinatologist, a health provider focusing on high-risk pregnancies.
When approaching SUD, Care Members must intervene early and prevent worsening conditions by working directly with members. They work in urban and rural markets to empower members to overcome barriers in achieving their health goals, making home visits if necessary. There is no one-size-fits-all approach to our SUD intervention and prevention, as each person’s needs and scenarios vary. By identifying her opioid dependency and by utilizing mHealth monitoring, Pam and Daniel were dedicated to providing the guidance and resources Sara needed to provide her the best possible health outcome for her growing family.
With each conversation, Sara’s trust in Pam and Daniel grew stronger. She always answered their phone calls, even if it wasn’t an ideal time to speak. It was through that trust that Sara began to utilize the recommended community resources to quit smoking at a prenatal care coordination program that Pam found for her.
Despite her early successes with prenatal care and taking the primary steps to quit smoking, her opioid use was deeply concerning to Daniel. He put together a customized plan for Sara, which involved speaking with a psychiatrist on a regular basis and taking Subutex, a drug used to treat opioid and narcotic addictions. Through Daniel’s support, she grew to enjoy her group therapy sessions and never missed an appointment, which ensured she received her medication on a regular basis.
“I couldn’t have asked for a better person to work with. She was always willing to take advice and give it a try.” Daniel, Care Manager
There were good days and bad days for Sara, but she never slipped under Pam and Daniel’s support. Her willingness to take advantage of every resource Pam and Daniel provided her was ultimately what led to the successful delivery of her boys. She delivered the twins at a hospital just three days shy of 37 weeks gestation. The delivery was such a success that she even delivered them naturally, which is rare with multiple births.
Daniel’s work, however, was not complete. As her care manager, he continues to follow up with Sara’s case on a regular basis, making sure she continues to take Subutex to curb her addiction. Sara also continues to participate in her group therapy sessions with her psychiatrist, despite her undoubtedly busy household. Through her SUD treatment from Envolve PeopleCare, Sara has been given the opportunities to be a better mother and self.
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33Broussard CS, Rasmussen SA, Reefhuis J, et al. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol 2011; 204:314:e1–11.
44Kellogg A, Rose CH, Harms RH, Watson WJ. Current trends in narcotic use in pregnancy and neonatal outcomes. Am J Obstet Gynecol 2011; 204:259:e124.
*Names have been changed to protect identities