Pregnant people who use substances need support. Peer recovery doulas can help

Michelle Kavouras was in labor when she waited for the best before heading to the hospital.

“I knew what was coming,” she said. “I knew I wasn’t going to be welcomed, given the situation that I was in.”

Kavouras was using cocaine during her pregnancy and decided to place her son for adoption. She spent the night in her hospital room with the baby after the birth. He was subsequently tested positive for cocaine and placed in the neonatal intensive-care unit. Kavouras recalls that the doctor came into her room within minutes.

“He was screaming at me, telling me, how can I do this to my baby, I’m selfish — things I already knew, didn’t need to hear from somebody shouting at me,” she said. “And instead of offering me any kind of help or anything, just wanted to shame me and make me feel worse than I already did, which was pretty impossible.”

That was 13 years ago, and Kavouras doesn’t want anyone to have to experience what she went through. She’s been in recovery for six years and now works with pregnant women at PCC Community Wellness on the west side of Chicago.

There are many obstacles that pregnant women and those who struggle with addiction face in getting the healthcare they need. Many fear mistreatment from health care providers and worry about the possibility they’ll lose custody of their baby due to their substance use.

Substance use has been identified as one of the main drivers behind the nation’s high maternal mortality rate. Mental health conditions — including suicide and overdoses related to substance use disorders — account for roughly 1 in 4 maternal deaths in the U.S., A new report says so From the Centers for Disease Control and Prevention.

 

 

Some states have taken steps to make it easier for pregnant women who abuse substances to access prenatal care, addiction treatment, and support them on their journey to recovery. And they’re getting help from people like Kavouras who know how challenging it can be.

Another type of doula

Kavouras is a doula — someone who provides physical and emotional support to pregnant people before, during and after childbirth. Doulas are non-medical professionals who help clients advocate for their rights in healthcare settings.

Kavouras, however, is more than a doula. She’s also a certified peer recovery specialist: someone who has experience with addiction and helps other people on their recovery journey.

Numerous studies have proven that a doula can be a lifesaver. Health outcomes can be improved Both moms and their babies. Women who receive continuous labor support are less likely to have a cesarean birth, and their babies are less likely to have low Apgar scores, a measure of babies’ health and well-being shortly after birth.

One small study involving women in recovery for an opioid use disorder found doula care reduced perceived stigma from health care providers and increased women’s perceptions of emotional support, health literacy and self-advocacy.

Kavouras’ work is part of a pilot program Peer recovery doulas were established in Illinois in 2019 for pregnant women with substance abuse disorders. The U.S. Substance Abuse and Mental Health Services Administration grants the funding for this program.

Doulas don’t just help with childbirth; they also assist parents after the fact. Dr. Ruchi FitzgeraldA family physician and an addiction medicine specialist, Dr. Alicia is the leader of the peer doula program at PCC Community Wellness. This health center is one of the participating ones.

Peer recovery doulas help clients access treatment, make prenatal appointments, and navigate complicated legal and medical systems.

“They can be a very strong advocate for our patients … preparing them for what to expect in a hospital setting, or possibly in family court,” Fitzgerald said.

The doulas also educate hospital staff on ways to reduce stigma, helping them understand “this is a person with a substance use disorder, this is not someone who has a moral failing,” Fitzgerald said. “We really want to promote a healing environment. And that’s been the most rewarding part of our program.”

The pilot program is offered in five Illinois health centers and has enrolled 242 women within its first two year.

At PCC Community Wellness, Fitzgerald said 51 people have worked with the peer doulas before or after birth in some capacity — like scheduling prenatal care, getting started on medication assisted treatment or enrolling in a treatment center.

Fitzgerald noted that it is hard to quantify the program’s success because so many things can happen after the birth. Sometimes, families split or patients leave treatment.

“What we found is that we don’t control all of the other systems,” Fitzgerald said. “And so we really try to have a public health approach, where we really focus on having the most healthy pregnancy and healthy birth in the hospital and then continuing to provide care to these patients, just like anyone else would receive care.”

Building trust is the challenge

One of the biggest challenges peer recovery doulas face is building trust with clients, especially if they’ve been treated poorly in medical settings in the past.

This means that doulas need to be able to demonstrate they’re part of their team. But it’s a complicated issue.

Substance use during pregnancy in 24 states and the District of Columbia is considered child abuse. Illinois law requires that clients report substance abuse to the state if they disclose it late in pregnancy.

Reporters are required to report on both peer recovery doulas and medical professionals. A report prompts an investigation by the state’s child welfare agency.

 

 

If a mother using substances wants to keep her baby, they must go through an investigation. Sometimes, this may be just days after giving birth. Showing that they’ve taken steps to get help for their substance use disorder can help their case but doesn’t guarantee they’ll be able to keep their child.

Carly Ann Braun has been a peer-recovery doula for several years in Illinois. She said some mothers worry that if they were to lose custody of their child, they’d start using substances again because they don’t know how else to cope.

“I’ve literally had a patient tell me, ‘The only reason that I’m not using drugs is because of my baby,” Braun said.

Trauma for moms, trauma for babies

Child welfare agencies have a mandate to do what’s in the best interest of the child. But it isn’t always clear what that means. Being born with a chemical dependence can be traumatizing for a child. However, it can also mean that they could lose their biological mother.

The process of a custody inquiry and ongoing child welfare checks can lead to separation. Michelle Brachter Goodwin, A law professor at University of California, Irvine

“This may be something that takes place [over] months that actually flow into years until she satisfies the state that she is suitable to parent her children,” she said.

Goodwin explained that she understands the concern mothers have about their babies being placed into foster care.

“There can be a lot of pain and a lot of abuse in those systems,” she said. “So now, not only has this mother been separated from her child, but now her children are also suffering in another kind of way.”

 

 

Braun shared that during her years working as a peer recovery doula, she saw some judges decide to seperate children from their parents even though the mother was in recovery or treatment. Braun believes judges and others within the criminal justice process lack an understanding of issues related perinatal substance misuse disorders.

“They have no understanding of treatment, they have no understanding of trauma-informed care,” Braun said. Education on substance abuse disorders is essential for any real change.

Even though it’s been more than a decade since she placed her son for adoption, Kavouras said it still pains her to think about it. It was difficult enough losing her child. The worst part of the entire experience was the mistreatment of hospital staff.

She uses that energy to help her clients as a doula today. She teaches them something she took a long time for to understand: they are worthy fair and compassionate care.

“And when they finally realize it and then they can start advocating for themselves because they are deserving of it, it’s pretty awesome to watch,” she said.

It’s incredibly hard work, Kavouras said, but it’s worth it.

“I love to see when somebody is like, ‘Oh, wait, you guys are so nice to me. Why are you being so nice to me?’” she said. “And I get to tell them, ‘It’s because you just deserve it.’”

This story comes from Side Effects Public Media — a public health news initiative based at WFYI. Follow Darian on Twitter: @HelloImDarian.