A new group of health care and social services experts gathered in Westport this week to discuss a vexing problem: the growing rate of Missouri babies born drug dependent.
The KC Perinatal Recovery Collaborative was formed because of data that shows the number of babies at risk of painful withdrawal symptoms in the first year of life has grown every year since 2011, going from 461 that year to 2,112 in 2016.
A change in the way such symptoms are diagnosed caused some of the spike, but federal official Kimberly Nelson said the overall trend is real and opioids are likely to blame.
"We see this illicit fentanyl (use) going up," said Nelson, the regional administrator for Kansas, Iowa, Missouri and Nebraska for the Substance Abuse and Mental Health Services Administration. "That's what's driving, certainly, the issues in Missouri and some in Kansas as well."
The Missouri numbers fit a national trend of rapidly increasing rates of neonatal abstinence syndrome, or NAS. According to the National Institutes of Health, by 2012 a baby was born in opioid withdrawal every 25 minutes in the United States.
New research from the Missouri Hospital Association suggests that the problem in that state may be even bigger than the data shows because of under-reporting.
In addition to pain and distress NAS causes, it also leaves the babies at risk for low birth weight and respiratory problems and leads to costly stays in hospital neonatal intensive care units.
According to Stanford Children's Health, NAS is usually treated with comfort care like swaddling and supportive care like extra calories and intravenous fluids. But some babies with severe withdrawal symptoms may need to be treated temporarily with drugs from the same family that created the addiction, until they can be weaned off.
Hendree Jones, a professor in the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine who was a featured speaker at the Westport meeting, said in most cases baby and mother should be kept together during that time, especially if the mom is in treatment.
Jones said breastfeeding eases the baby's withdrawal symptoms. If the mom is on methadone, the baby will get a small dose of that through the breast milk, but Jones said that's only a small factor in what comforts the child.
“It’s the act of breastfeeding," Jones said. "It’s the fact that you’re going to swaddle your baby, you’re going to look the baby in the eyes, it’s going to have that skin-to-skin contact, it’s going to have that sucking.”
The KC Perinatal Recovery Collaborative was formed to find ways to both prevent NAS and treat it more effectively.
One thing the experts all agreed on: stigmatizing the mothers for using drugs is counterproductive.
"Judging won't change their behavior," said Jodi Jackson, a neonatologist at Children's Mercy Hospital and Shawnee Mission Medical Center.
Instead, Jackson said the focus should be on supporting women and addressing the socioeconomic issues that lead them to use drugs.
She also advocated for universal drug screening for all pregnant women through physician interviews and better access to prenatal care.
Others said post-natal care for the women is also lacking, in part because many of them lose the Medicaid coverage they got for being pregnant as soon as they deliver their babies.
The Missouri Legislature passed a bill this year extending Medicaid coverage for new moms for 12 months for substance abuse treatment and related mental health care.
Several people at this week's meeting said there's not enough drug abuse treatment options in the Kansas City area and women who are uninsured or on Medicaid are particularly vulnerable to having no place to go after they're discharged from the hospital.
A combination of intensive counseling and medication-assisted treatment with drugs like Suboxone and methadone is considered the gold standard for treating opioid addiction. But doctors need a special federal waiver to prescribe those drugs and Missouri has a severe shortage of providers who have it.
Kim Davis is the executive director of Amethyst Place, which provides housing to women in recovery. She said even those who get into treatment programs face a myriad of other challenges, from poor public transportation to a dearth of job opportunities and housing situations that leave them vulnerable to relapse.
"We obviously need more long-term sober housing," Davis said.
There are numerous challenges for mothers who face drug addiction, but Oneta Templeton said the societal response this time around is much different than in the 1980s and 1990s, when women who had children born addicted to cocaine were routinely stigmatized and criminalized.
"We didn't talk anything about incarceration or throwing people in jail (today)," said Templeton, a social worker at Children's Mercy Hospital. "(In the 1980s) we (in social work and health care) were the only ones who were talking about not doing it. Now everyone's talking about not doing it."