WISH center gives moms with substance disorders keys to a healthier pregnancy and family life

July 1, 2022

By RENEE STOVSKY

In 2019, when Anjel Ridgel was five months pregnant with her third child, she began to panic.


WISH Center phlebotomist Janae Alton, right, takes the vitals of patient Anjel Ridgel. The Women and Infant Substance Help Center at SSM Health St. Mary's Hospital in Richmond Heights, Missouri, earned CHA's Achievement Citation.
Photo by Jerry Naunheim Jr. © CHA

Six years earlier, she had been in a car accident that left her with excruciating back pain. Her doctor had prescribed Percocet, a combination of acetaminophen and the opioid oxycodone. When her prescriptions ran out, she found herself buying it on the street. She had become addicted to the drug.

"I knew that crack and heroin were problems in pregnancy, so I worried about how pain pills could affect my baby," she says.

Ridgel sought a referral at the health clinic she was attending and was directed to the WISH Center at SSM Health St. Mary's Hospital in the St. Louis suburb of Richmond Heights, Missouri. The WISH acronym is short for Women and Infant Substance Help.

"I didn't know what to expect when I got there, but the staff was very supportive and nonjudgmental," she says.


Perched on his mother Brittany Eich's lap, Jaxson Laird, 2, is the center of attention during her follow-up visit to the Women and Infant Substance Help Center at SSM Health St. Mary's Hospital in Richmond Heights, Missouri. Mona Rife, left, a perinatal care coordinator at the WISH Center, engages with Jaxson. The WISH center provides prenatal and other care to women with substance use disorder.
Photo by Jerry Naunheim Jr. © CHA

After an initial assessment, Ridgel was seen by an OB-GYN with a specialty in maternal-fetal medicine. She received an ultrasound and agreed to begin a supervised withdrawal followed by a medication-assisted treatment program which combines behavioral therapy with, in her case, Subutex (buprenorphine), to reduce drug cravings.

Changing the script
Her daughter, born four months later, had a rough start in life. She spent 10 days in the neonatal intensive care unit battling neonatal opioid withdrawal syndrome and received a blood transfusion.

Ridgel and her baby continue to get postpartum services through the WISH Center. Though relapses are common among opioid users, Ridgel, now 36, has stayed completely sober, and she and her three children are thriving. Now on a very low dose of Subutex, she hopes to stop using it altogether soon.

She works as a certified nurse assistant at a senior living facility and recently finished her training as a certified medication technician. She now owns her own home, and ultimately wants to become a registered nurse.

Recently, Ridgel learned that both of her parents, who died when she was a young girl, succumbed to heroin overdoses. She is one of eight siblings, and says that every one of her brothers and sisters, save one, has battled substance dependence issues. Her two oldest brothers died from drug usage.

"Thanks to the care I've received at the WISH Center, I feel like the sky is the limit for me now," she says. "Everyone there operates from love. I'm just so grateful to have found it."

Enfolding women and babies
For its innovative approach to providing prenatal and postpartum care for pregnant women dependent on opioid drugs as well as methamphetamine, benzodiazepines, cocaine, alcohol, cannabis and tobacco, the WISH Center is the 2022 recipient of CHA's highest annual honor — the Achievement Citation. The award was presented June 6 at the Catholic Health Assembly in Indianapolis.


Chavan

"The number of programs like WISH in the U.S. are at most in the double digits," says WISH Center Medical Director Dr. Niraj Chavan. An OB/GYN maternal-fetal medicine specialist certified in addiction medicine, Chavan became medical director over the WISH Center late last year when the founding physician Dr. Jaye Shyken retired.

Chavan says of the WISH Center: "We aim to be a one-stop shop where we can offer not only medical and prenatal care but also holistic care, both here and by partnering with community providers to address biopsychosocial needs that can impact outcomes for mothers and babies."

Patients at the WISH Center present with a mosaic of problems; Chavan estimates that half are addicted to opioids, methamphetamine or cocaine, while the rest are evenly split with addictions to alcohol or benzodiazepines. They find their way to WISH through different routes — some self-refer, while others arrive because they have learned of this option from their OB physician, or from family members, primary care physicians, community organizations or drug courts. Patients often face barriers to care, which may stem from provider bias against women with substance dependence disorder. Most patients have behavioral health diagnoses as well. This compounded by broken family lives, housing insecurity, poverty, low educational attainment and lack of reliable transportation can compound the challenge of accessing care.

"We know that the biggest missed opportunity for care is when patients don't make it to their first appointments,"

Chavan says. "That's why we try to engage them from their very first phone call, whether they are in their first trimester, a week away from delivery or even postpartum."

First impressions
Jackie Seabaugh, lead nurse at the WISH Center, is usually a patient's first contact point. "I explain our program, ask about their drug of choice, go over their history of substance use, and make their first appointment," she says. At the initial visit, a doctor or nurse practitioner checks vitals and takes a lengthy patient history, including drug usage, efforts to go through rehabilitation and co-morbidities. Patients are screened for underlying psychiatric disorders and adverse childhood experiences, which are linked to substance dependency.


Seabaugh

Social workers determine whether the patient has a stable relationship with a partner and enough to eat. Housing-insecure patients or women at risk of abuse may be referred to a Catholic Charities residential home for pregnant women.

"We make it very clear that there is no stigma about drug use here; we want to reframe in their minds that addiction is a chronic disease, not a moral failure. Building a trusting relationship is a powerful tool on the road to recovery and sobriety," says nurse practitioner Cara Schagemann.


Schagemann

Call to care
The WISH Center began as a small, half-day subspecialty clinic within the obstetrics/gynecology residency program at SSM Health St. Mary's in October 2014 after its first medical director, Dr. Jaye Shyken, an OB/GYN who specialized in high-risk pregnancies, noticed an alarming increase in pregnant patients using the opioid fentanyl. (According to a National Institute on Drug Abuse report in 2015, there was a fivefold increase in the number of babies born dependent on opioids from 2000 to 2012, with an estimated 21,700 babies diagnosed with neonatal opioid withdrawal in 2012.)

Within a few months of operation, without any advertising or promotion, the clinic had a backlog of three to four weeks for appointments.

Shortly thereafter, Donna Spears, director of maternal services for SSM Health St. Louis, put together a proposal for a $1.36 million investment in a 3,600 square foot, stand-alone site. It opened in 2016, operating 4.5 days per week and serving a broad spectrum of patients throughout Missouri and central/southern Illinois.

Today, care is administered by a 17-person team that includes two physicians, nurse practitioners, nurses, a psychiatrist, social workers (two antepartum, one exclusively postpartum), a pharmacist and a sonographer. The annual operating budget is $1.1 million, including salaries.

"Part of our mission is to strengthen families and protect mothers and babies," says Spears. "Many of these women have lost family and relationship support because of addiction. They don't feel like productive members of society, and there are many trust and mental health issues involved. I felt strongly that we couldn't turn away from this kind of care."

Medication-assisted treatment
If WISH patients have an opioid use disorder, clinicians offer to start them on buprenorphine or refer them to a methadone clinic. For other substance misuse — alcohol, marijuana, cocaine — there is no pharmaceutical therapy, and recovery can be more challenging. Detox programs, social support through organizations like Alcoholics Anonymous and Narcotics Anonymous, and group and/or individual therapy to treat mental health issues like depression and help build coping skills to maintain sobriety are central to treatment plans.

Follow-up appointments are made weekly, biweekly, even once a month — depending on the stage of pregnancy and treatment choices. Drug screenings are conducted at each visit. Relapses are not uncommon.

"We don't play a blame game," says Chavan. "We normalize relapses as part of the journey and use them as an opportunity for regrouping and getting back on track."

More than 95% of WISH Center patients deliver at SSM Health St. Mary's, says Chavan, and upwards of 80% are drug-free when they give birth.

Eat, sleep, console
Through education offered to labor/delivery staff, the WISH Center has changed the culture of care for infants with neonatal opioid withdrawal as well. Traditionally, newborns who exhibit signs of drug withdrawal — muscle rigidity, chills, abdominal cramping — have been given morphine to ease their withdrawals. Now standard practice at St. Mary's is to use "eat, sleep and console" methods including skin-to-skin contact between mothers and babies, swaddling, breastfeeding and rocking. As a result, the average NICU stay for newborns in withdrawal has been reduced from more than 17 days to six or seven, says Spears.

Because the challenges of postpartum life substantially raise the risk of relapses, the WISH Center also has a robust program, funded through a partnership with United Way, to support new mothers and babies for up to three years following delivery. Patients continue to receive buprenorphine prescriptions as needed, and social workers are able to help access everything from subsidized housing and pediatric appointments to diapers, cribs and car seats to improve outcomes for a healthy, drug-free life.

Though there are no statistics yet to show how many WISH Center patients achieve long-term sobriety, the staff takes pride in knowing they have helped some 2,500 women.

"The greatest thing about this job is that when women reach recovery, they have life change," says Schagemann. "And we get to be part of that story for them — mending relationships in their lives, teaching them both parenting and self-care skills, coordinating care to equip them for sobriety. It's such an honor to help with those life changes."

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