Pregnant and on Opioids? In St. Louis, There's a Medical Center for That 

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Rio Clemens sits with her daughter Kylie, while talking with Dr. Jaye Shyken. - NICK SCHNELLE
  • Rio Clemens sits with her daughter Kylie, while talking with Dr. Jaye Shyken.

As the nation's opioid crisis worsens with no letup on the horizon, it has led to record numbers of babies suffering from NAS.

Every 22 minutes, on average, a child is born in the United States with NAS. An estimated 24,000 babies — a five-fold increase since 2000 — were born in the U.S. in 2013 with the syndrome, according to the federal Centers for Disease Control and Prevention.

Meanwhile, the number of overdose deaths continues to set new records, with almost 64,000 Americans dying from drug overdoses in 2016, though many experts think the true number is much higher. At least 250 people in St. Louis alone died that year from opioid overdoses — also a record.

In large part because of overdose deaths linked to the opioid crisis, life expectancy in the U.S. has fallen for the second year in a row, the first time it's dropped for two consecutive years in more than half a century according to figures released in December by the CDC.

The WISH Center is the only place of its kind nationwide. No other program does the work it does — providing detox services for pregnant women while helping them through pregnancy and caring for their babies afterward. As such, it serves as a template for similar programs being set up in other cities.

The WISH Center officially began as a full-time, freestanding facility fifteen months ago. Today it serves an average of 120 patients per week and employs a staff of twelve full-time workers or their equivalents, including nurse practitioners and pharmacists. It offers the equipment, trained staff and resources to provide prenatal care, substance-abuse treatment and relapse-prevention help for up to two years after birth.

The center, which is led by SLU maternal-fetal medicine physicians, also provides financial counselors to help patients apply for Medicaid, the federally funded health-insurance program for low-income families, and it connects them to social-service programs to provide job training and other aid, according to Donna Spears, SSM Health's director of maternal services.

"Because the goal is to keep mom in sobriety into the next pregnancy, hopefully for a lifetime," Spears says. "That's why we had to engage with organizations that really have more experience and resources in that area."

Shyken came up with the idea for the WISH Center more than three years ago. At the time, it was just a half-day-a-week pilot project.

"And it was pretty clear that we were way over-subscribed," she says. "We didn't do any advertising. Just taking existing people and using word of mouth."

The board at SSM Health St. Mary's soon bought into Shyken's vision and made a $1.2 million capital investment, locating the facility in a nearby medical office building in Richmond Heights. A satellite is set to open in Carbondale, Illinois, by April 1.

For St. Mary's, the decision to open the WISH Center was straightforward, says Spears. Still, she knows the type of medicine the WISH Center practices is not easy, which helps account for the dearth of competitors.

"Many folks don't exactly want to take this on," Spears says.

Of patients, she adds, "They have many other conditions related to their illicit substance abuse. And a lot of physicians don't have the training or the time needed to work through all the different social aspects and all the things that go along with training these patients."

Women with opiate addictions sometimes present with infections in their blood or skin abscesses from using dirty needles to inject drugs, Shyken says. And often her patients need antibiotics for long periods of time.

"This is not a population you can send home with an IV to get home antibiotics," Shyken says. "Not going to send an IV drug user out with an IV. So they're sort of in the hospital for six weeks."

Underlying mental-health conditions, such as depression, severe anxiety or dealing with the aftereffects of childhood abuse — conditions that might have contributed to patients abusing opiates in the first place — can also present a complication.

"We know drug use associated with anxiety and depression and hopelessness that just comes as a result of the changes in their lives because they're using drugs," Shyken says. "But some of this occurred before their drug use, and the drug use is really self-medication, and their best chance of prolonged sobriety is going to be treatment of both."

Still, a central part of the WISH Center's vision is to make its patients feel welcome and at ease, to feel like any other pregnant woman at an OB-GYN office.

"Because until we normalize this as much as possible, people won't seek treatment or they'll fear the criminal part of it," says Spears. "That's the whole reason we created this center and put it in the area we did."

That fact that WISH Center is in a medical office building, not a hospital, is intentional. "We put it in the same area as other physician offices because you need to feel like that," Spears says. "It needs to feel like you're doing any other routine OB visit that you encounter. It can't feel like a heroin treatment facility. People aren't going to go to that."

But there are important differences from other OB-GYN offices.

For instance, WISH Center offers women who are in withdrawal handheld showers in rooms with special drains. "The reason why is if that mom gets sick and vomits on herself when she's going through induction of buprenorphine, we wanted her to be able to take a shower," Spears says. "Because that's a dignity issue. We keep clothes there. So she could change and not have to leave in vomity clothes."

Pregnant women addicted to opioids often feel an intense sense of shame and stigma, which is a big reason many don't come in for treatment, Spears says.

"They're committing the worst offense against humanity in many people's minds," Spears says. "That's what people are so judgey about. Let's not judge them. Just open the door, be so glad that they sought out help and take it from there."

Chad Sabora, the co-founder of the Missouri Network for Opiate Reform and Recovery in south St. Louis, says that Shyken and the WISH Center are doing "amazing, crucial work."

The WISH Center "is a piece of the puzzle that needs to be in every state. And we need to keep families together," Sabora says.

Sabora contrasts the thinking behind the WISH Center with punitive attitudes in places like Tennessee, which in 2014 passed a law that empowered local law enforcement to lock up pregnant women who abuse drugs.

"You got a pregnant woman? Lock her up," Sabora says. "There's no prenatal care in jail. It's the most absurd, ass-backwards solution to helping a pregnant woman with an opioid disorder. Tennessee is a shining example of the mentality of a lot of this country. 'Get that woman in jail.'"

The WISH Center's emphasis on preserving the mother's dignity is why she keeps coming back after initial misgivings, Clemens says.

"They are this good and this professional," she says. "Because most people, when they think drug-addict mother on Medicaid, they're going to go to some clinic. They're going to sit there for five hours, nobody really gives a damn. It's so nice to be able to come to a place like this."

Shyken has been a huge part of what keeps her coming back.

"When I very first met her I was definitely overwhelmed and scared," she says. "But she talks to you, she explains everything to you, she walks you through everything. I mean, she just makes you feel comfortable. Like, 'You can do this and get through this.'"

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