Ashley can still remember the shame she felt when confronted by this question in the hospital just hours after she gave birth to her son. The harsh judgment didn’t come from a fellow patient but from someone providing her care.
“This is exactly the kind of response that makes mothers hide their addiction,” she shares. “When women can’t even get support from medical professionals, but instead get shamed, getting high can feel like the only option. It’s a vicious cycle.”
Confrontations like the one Ashley describes are driven by the mistaken belief that addiction is a moral failing, rather than a disease process exacerbated by childhood trauma and family histories of addiction. This lack of understanding – even within the medical community – is exactly what Project CARA was designed to address.
Project CARA (Care that Advocates Respect/Resiliency/Recovery for All) is a substance use disorder clinic for pregnant women provided through Ob/Gyn Specialists at the Mountain Area Health Education Center (MAHEC). The Asheville-based clinic supports women with high-risk pregnancies from 16 counties in Western North Carolina. The innovative program, now in its second year, is a response in part to the national opioid epidemic that has hit WNC communities particularly hard. Our region ranks among the top in the state for fatal overdoses and has higher-than-average rates of opioid pills prescribed per resident.
“In 2016, we supported 200 pregnant women with substance use disorders,” shares Melinda Ramage, FNP, Project CARA’s clinical director. “We are on track to see twice as many women by this year’s end.”
What about the stigma that keeps addiction hidden, especially among pregnant women?
“We are very careful to make sure women feel safe and respected enough to share potential substance use issues,” Ramage shares. “We work hard to reduce the shame and blame around addiction.”
Establishing this trust is critical because it isn’t always obvious which patients are struggling with addiction, which cuts across all socioeconomic lines. Ramage saw this firsthand when she worked with impaired professionals at a residential treatment center in Mill Spring.
Project CARA’s collaborative team includes MAHEC’s maternal-fetal medicine specialists, nurse practitioners, behavioral health specialists, and outside partners like the Women’s Recovery Center, Julian F. Keith Alcohol and Drug Abuse Treatment Center, and Mission’s Neonatal Abstinence Syndrome delivery preparation team, who all meet and assess patients during their prenatal visits.
“We know that women are more likely to get the recovery support they need when we combine it with prenatal visits,” shares Marie Gannon, LCAS, LPC, Project CARA co-founder and team member. “Pregnancy can be a positive experience, but it’s also stressful. It’s even more stressful for someone who has given up their primary coping mechanism, one they have literally become dependent on.”
Women with substance use disorders are at the highest risk of relapse when they are pregnant. This puts both moms and babies at risk. To help reduce this risk, Project CARA offers medication-assisted therapy (MAT), which involves the supervised replacement of opioids with buprenorphine. This approach is endorsed by both the American College of Obstetrics and Gynecology and the American Society of Addiction Medicine.
Women receiving opioid replacement therapy are much less likely to relapse than those using opioid blockers or abstinence-only approaches. MAT may also reduce the likelihood of alcohol use during pregnancy. Alcohol consumption is known to increase the risk for birth defects. Project CARA participants also have access to recovery education and group support provided by Denise Weegar, MA, LCAS, co-director of the Women’s Recovery