Michael Marcotte, M.D., Maternal-Fetal Medicine, Good Samaritan Hospital
—As told to Lisa Murtha
We started working here in 2008; a grant transferred from the University of Cincinnati brought us a social worker specifically focused on helping pregnant women who had substance use disorder. Back then we were averaging around 20 women a year.
In about 2012 we started to see more patients coming to us with substance use disorder. We started to see more heroin. Our addiction specialist was becoming overwhelmed with the number of women showing up asking for help. As a maternal-fetal medicine specialist—somebody who deals with the most complicated pregnancies, affecting both the mother’s health and the baby’s—it seemed pretty natural to venture into this area, so it’s been about seven years that I’ve been actively involved. My role is really as advocate for our program.
When I first started, I didn’t have a clear sense of what the patients’ goals were. I started to ask, “What brings you here?” They always say the same thing: They want sobriety. The life they have been living is a difficult life filled with suffering, pain—constantly focused around not having sickness from withdrawal. The second thing is, they’re pregnant and they want to be parents, but realize their current lifestyle is not compatible with parenting. They need help to figure out how to get to a place where they can parent.
The backbone of our program is outpatient prenatal care that follows the standard prenatal care schedule, but we have additional services we provide, including two full-time social workers to help our patients bridge to community resources. The majority of women need medication-assisted treatment, so we will often start methadone, buprenorphine. We get involved with the probation system and the court system to advocate for the women. We have a full-time nurse case manager. We have a nutritionist. We have a community health worker who works with our moms after delivery to provide support so they can maintain sobriety and continue to parent or work with child protective services to get in a position where they can parent.
One of our big markers is how many of the babies that were born to our moms required treatment for Neonatal Abstinence Syndrome. Last year our number was 19 percent. Compare that to what’s been published in the literature, [and] we’re about half of what the [national] rate is.
Last year we had unique contact with about 500 women in the HOPE program. Of those, we had 186 women go through pregnancy and delivery, so a little less than half of our moms actually stay with us and get through a program. I’d like to see that number go up.
A lot of our young women came from a life surrounded by addiction and social stress, and we want to help them break that cycle. HOPE [stands for] Helping Opiate-addicted Pregnant women Evolve. It’s a good word because our program is about bringing hope to people who often feel hopeless. They feel that they’ll never be able to parent, and they feel that they’re never going to get sober. And we can help them. I always tell women when I first meet them, “We can help you. Let us help you.”