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Dr. Jaye Shyken, left, greeted Jennifer Kostoff, a recovering addict from Granite City, Ill., and her then-6-week-old daughter, Rikki, last year at the SSM Health Woman and Infant Substance Help Center at SSM Health St. Mary’s Hospital in Richmond Heights. Dr. Shyken is medical director of the WISH Center, which offers comprehensive maternity care to pregnant women who are dependent on heroin or other opioid drugs.
Dr. Jaye Shyken, left, greeted Jennifer Kostoff, a recovering addict from Granite City, Ill., and her then-6-week-old daughter, Rikki, last year at the SSM Health Woman and Infant Substance Help Center at SSM Health St. Mary’s Hospital in Richmond Heights. Dr. Shyken is medical director of the WISH Center, which offers comprehensive maternity care to pregnant women who are dependent on heroin or other opioid drugs.
Photo Credit: Sid Hastings

WISH Center counters tragedy of drug-addicted babies

Clinic at SSM Health St. Mary’s Hospital takes multi-disciplinary approach

New mom Jennifer Kostoff and her baby already had six wonderful weeks together. You could tell the delight in Kostoff’s eyes as she looked at her baby girl, Rikki, cuddling her and showing her off.

But it very easily could have been a gut-wrenching time. Rikki could have had a baby born with heroin addiction.

Heroin slows the growth of a baby both during and after pregnancy. Without medical care, according to treatment providers, it’s four times more likely that a baby will die during pregnancy or shortly after being born. The baby will simply be too small to survive.

Babies of heroin addicts who survive weigh about one-fourth less than average infants, and many are born prematurely. Even a year after birth, most babies of mothers who used heroin while pregnant are smaller than average, and have smaller heads. And if the mother fails to get treatment for her addiction, there’s a good chance the baby will experience heroin withdrawal, which can cause it to suffer for months.

Kostoff had been in recovery for three years after kicking an addiction to heroin. She had a lot of trauma earlier in her life, and stress led her to begin using again. It was a form of pain relief for her, “completely numbing me,” she said. “It took me to a place I didn’t have to feel anything at all. I was using to survive, not using to have fun.”

A month later, she learned she was pregnant.

Her baby was lucky, though, because Kostoff sought help and found it at the WISH (Women and Infants Substance Help) Center at SSM Health St. Mary’s Hospital. The multidisciplinary clinic provides coordination of chemical dependency treatment, maternal-fetal medicine, subspecialty care, social services, neonatology counseling and patient education.

Kostoff’s first appointment lasted six hours, and she soon was on medication that helped wean her from heroin. “I had to get healthy because I did not want to use,” she said. “I knew I’d go back to it if I didn’t get the help I needed.”

Rikki was born premature April 5, 2017, but was not addicted to the drug her mother had used early in her pregnancy.

The WISH Center saved her, Kostoff said. “A lot of women are scared to get help. They’re afraid of what people will think of them if they know they’re pregnant and using.”

People criticize pregnant women who are addicted and continue to use, but they don’t understand the difficulties the women face, Kostoff said. “It becomes a physical need. You want to stop, you want help and you don’t want to use. But sometimes it’s so overpowering on your body, you’ll do whatever you have to do to feel better.”

That’s where the WISH Center came into her life, she said. “I was able to have a healthy baby, bring her home and not have any issues. And I’ve stayed clean afterward. That’s so important, too.”

A vital part of her recovery is a 12-step program. Kostoff went to nine meetings a week during her pregnancy and now goes to four meetings a week and is a sponsor for other women

She also has a 10-year-old. She believes in God, puts Him first, her recovery second and family third. “God drives my bus today,” she said. “I’m grateful for that. I work on my recovery and am able to have a life.”

Kostoff and her physician at the clinic, Dr. Jaye Shyken, have several long talks. “She’s as much a friend as a doctor,” Kostoff said. “I will always have contact with her the rest of my life. She’s very attentive to the needs of women in addiction and recovery.”

Women need to know they’re not alone and that people care for them, Kostoff said. WISH Center and Catholic Charities’ Queen of Peace Center show that needed care.

Shyken became interested in the specialty while doing a fellowship in fetal maternal medicine at the former St. Louis Regional Hospital in the late 1980s during the height of a cocaine epidemic. The drugs of choice have changed but the aspects of addiction, a relapsing, chronic disease has stayed the same.

“What we are recognizing now is that it takes a multi-disciplinary, multi-faceted approach to addiction” in treatment because of the various ways people come to be addicted, Shyken said.

The majority of patients come from referrals of other physicians who identified a substance-abuse disorder. The goal is to start expectant mothers on buprenorphine or methadone — which alleviate withdrawal symptoms from opiods and help curb drug cravings as early as possible to minimize complications and reduce the length of the hospital stay for newborns.

“We don’t turn people away,” Shyken said. “But the prospects for being able to achieve a sustained recovery are going to be less the later we are in the pregnancy.”

Neonatal abstinence and withdrawal syndrome in the newborn tend to be worse when people are abusing multiple drugs and heroin.

Shyken, associate professor of obstetrics, gynecology and women’s health at St. Louis University and a SLUCare maternal fetal Medicine specialist, pitched the idea for the WISH Center a couple years ago to Donna Spears, director of maternal services at SSM Health. Spears found a large number of maternal patients with substance abuse. With those statistics, the board agreed to begin the program, which went from half day to a full-time operation. It’s mission-driven and a ministry.

Addiction is a brain disease with a powerful hold in which “just saying no doesn’t work,” Shyken said. Narcotics permanently alter the brain and what is demonstrated to work best is medication assistance and intensive chemical dependency treatment. If the women aren’t committed to being sober, they won’t be able to maintain their families.

The WISH Center works with other agencies, including Queen of Peace Center and Our Lady’s Inn.

“This drug is so powerful it gets in between the most primal of all bonds, which is mother and baby,” Shyken said. “It’s not something people choose — to be addicts. It’s something that happens as a result of a bad decision or two. It speaks to our ability to forgive, to offer help and offer hope. Many treatment programs have spirituality at their core, the AA programs for example. There is a certain recognition of a certain power and a powerlessness against this addiction.”

Heroin doesn’t discriminate, Shyken said. “It’s not just Medicaid patients. It’s in our family. It’s our sisters, our daughters and our neighbors.”

To date, SSM Health has invested $1.2 million into the WISH program, which also includes a satellite office in Carbondale, Illinois, and expanded the facilities in St. Louis.

The explosion in use of heroin in the St. Louis community has consequences for not just newborns but the other children of addicts, separated from their families when placed in foster care of cared for by other relatives. Catholic agencies struggle to keep up with the need but quietly do the work of trying to make the families whole.

Symptoms

Heroin use during pregnancy can result in neonatal abstinence syndrome (NAS). NAS occurs when heroin passes through the placenta to the fetus during pregnancy, causing the baby to become dependent along with the mother. Symptoms include excessive crying, fever, irritability, seizures, slow weight gain, tremors, diarrhea, vomiting and possibly death. NAS requires hospitalization and treatment with medication (often morphine) to relieve symptoms; the medication is gradually tapered off until the baby adjusts to being opioid-free. Methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the outcomes associated with untreated heroin use for both the infant and mother, although infants exposed to methadone during pregnancy typically require treatment for NAS as well.

National Institute on Drug Abuse


Heroin addiction

Heroin and opiates in the St. Louis area

• 80 percent of people admitted to treatment for heroin started with prescription pain medications

• Heroin and prescription pain medications are derived from the same plant, the poppy. These highly addictive drugs are in a class called opioids.

• In the past several years, the purity of street heroin has drastically increased, allowing it to be snorted instead of having to be injected. The purity of heroin is never known to consumers. It can be cut with more potent drugs or diluted. This uncertainty drastically increases the chances of an overdose.

• Opioids are depressants. This means that heroin slows breathing and heart rate until both just stop.

• In the past decade, thousands in St. Louis have died from opiate overdoses.

Warning signs

Rapid change in behavior, friends, hygiene or appearance; Empty pill capsules, missing spoons, used to cook low grade heroin; Cut straws, used to snort heroin; missing electronics or other valuables, often pawned to support an expensive opioid addiction

If you think a friend or family member may have a problem, call the National Council on Alcoholism and Drug Abuse at (314) 962-3456 or visit wwwncada-stl.org.

WISH Center counters tragedy of drugaddicted babies 2

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