ACOG’s Provider’s Partnership, supported in part by the College’s Annual Fund, tackles many issues related to maternal safety. One of the most important areas is finding ways to support ob-gyns in their efforts to provide quality care for pregnant women who have substance dependence.
A pregnant woman addicted to prescription drugs or opiates may delay prenatal care and drug treatment for fear of legal penalties or losing custody of her children. This fear may be justified: In some jurisdictions, a woman must plead guilty to child neglect to be seen at a family drug treatment court. As a result, she relinquishes her right to a defense, is placed on the state list as a person who maltreats children, and suffers restricted housing and employment.
What’s more, some courts mandate that pregnant women undergo withdrawal and detoxification, which can be dangerous to the fetus, causing preterm labor, fetal distress, and pregnancy loss. The National Institute on Drug Abuse estimates that there are “between 26.4 million and 36 million people abusing opioids worldwide, with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted to heroin.” While some physicians find it hard to believe that any of their patients have an addiction issue, odds are that some do—and are afraid to discuss it.
Understanding the unique complications pregnant women face, ACOG’s Provider’s Partnership collaborated with Fellows and staff to develop a toolkit to help guide patient wellness visits by encouraging nonthreatening screening and entry to substance use treatment. Additionally, the Partnership collaborated in training 25 obstetricians and gynecologists on the use of buprenorphine, which has a lower risk of overdose, fewer drug interactions, the benefit of allowing treatment on an outpatient basis without the need for daily visits to a licensed treatment program, and evidence of less severe neonatal abstinence syndrome. (For more on buprenorphine, see the Committee Opinion Opioid Abuse, Dependence, and Addiction in Pregnancy.)
Launched in the early 1990s, the Provider’s Partnership allows the College and the federal Department of Health and Human Services to coordinate maternal and child health (MCH) activities between federal and state MCH programs. Currently, the Partnership is focused on maternal safety, substance use, and disaster planning. Through the Partnership, state MCH directors have access to ACOG materials, particularly Committee Opinions, Practice Bulletins, and other guidelines, to develop state regulations and promote the most current practice guidance. State MCH leaders have direct access to Partnership staff who are able to triage technical questions to appropriate College staff or Fellows.
To support the Provider’s Partnership and programs like it, please consider donating to the Annual Fund. Membership dues represent only 32 percent of the budget; without donations, programs on maternal opiate use would not exist. Giving is easy! You can either make a donation online or mail a check, made payable to the American College of Obstetricians and Gynecologists, to 409 12th Street SW, Washington, DC 20024.