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.
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.
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.
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.
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.
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.
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
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,
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.”
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
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
Neonatal abstinence and withdrawal syndrome in the newborn tend to be worse when people are abusing multiple drugs and heroin.
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.
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.
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.”
discriminate, Shyken said. “It’s not just Medicaid patients. It’s in
our family. It’s our sisters, our daughters and our neighbors.”
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
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 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
• 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.
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.