Addressing an urgent community need
At the same time that they are dealing with what can be overwhelming challenges related to their substance use disorder, they also have specific health needs and risks in pregnancy. Pregnant women with substance use disorders, especially related to opioids, are at higher risk for miscarriage and stillbirth, and their babies are also more likely to be born early and have a low birth weight.
The first year postpartum may also be a dangerous one: Opioid overdose deaths decline during pregnancy and peak seven to 12 months postpartum, according to a 2018 study published in the journal Obstetrics & Gynecology.
The benefit of the Maternal Substance Use Disorder Clinic, says Alison Lynch (98MD, 03R), UI clinical professor of psychiatry and family medicine, is that the health care professionals involved in patient care don’t stigmatize their patients.
“We recognize that they are dealing with a health condition that doesn’t just turn on and off, and it’s not about choices or not wanting [treatment] hard enough,” says Lynch, who is also the director of the UI Addiction Medicine Clinic. “To watch them be able to get treatment and be treated with respect ... I’ve seen so many people transform their lives when they do get access to care.”
How the clinic works
Through an IDPH grant, the program was designed to increase screening rates for substance use for pregnant women. At OB-GYN clinics at UI Hospitals & Clinics, all pregnant women are screened at their first obstetrics visit and again at 28 weeks. If a woman discloses that she uses substances, or she tests positive on a urine drug screen, she is asked if she’d like to be referred to the clinic.
Hambright adds that they also coordinate with different agencies in Iowa “to let them know our clinic exists, so we can help the greatest number of patients that we can.” They also emphasize to these agencies that they will work with anyone from around the state, not just those who live near Iowa City.
“It’s really common, after being a victim of abuse and assault, to channel really strong negative emotions inward, such as shame, worthlessness, and lack of self-esteem, all of which are fuel for substance use,” she adds.