Dr. Jeannie Kelly and Dr. Bridget Galati both work at CARE — the Clinic for Acceptance, Recovery, and Empowerment. It's a part of WashU Medicine in St. Louis, and offers prenatal and postpartum care, as well as substance use disorder treatment for pregnant people facing addiction.
They spoke about how substance use disorder treatment during pregnancy can help parents — and babies thrive.
For the month of September, we’re focusing on substance use disorders and some of the treatment options that exist for Missourians.
Dr. Jeannie Kelly: I think most people are so scared by fetal harm that comes from any treatment that the first instinctual response for someone, who's not an obstetrician, is to say, "Don't take any medications. Don't expose the baby. Don't do that. Don't get that imaging.”
But it's never: “Do I expose this baby to a medication or not?” That's not the comparison, right? The comparison is: “Do I expose this baby to this medication and this treatment, or do I expose this baby to untreated or undertreated disease?”
And so, I think we know the harm and the risk is tremendous with untreated disease. We also know that we have really effective interventions and medications that prevent those harms and those risks.
Namely, you know, opioid replacement therapy using two medications, known as buprenorphine or suboxone or Subutex, and methadone.
Those are opioids, but they are worlds safer than any of these sort of like non-prescribed substances that are available. They have decades of data to support their efficacy and to support their safety.
I think people don't recognize how important these medications are to overall health and survival. There's a lot of stigma involved with it. There's a lot of like, “You're replacing one addiction for another,” but we would never tell someone with diabetes, “Hey, like your insulin that you're using is a crutch.”
Dr. Bridget Galati: Yeah, I mean, I don't think I met a patient that came into our clinic was like, you know, “I wanted to be an addict.”
They don't choose this. This isn't a choice, you know? It's a chronic neurobiological disease that needs treatment and needs extensive wraparound treatment, not just during pregnancy but postpartum.
There's so many people that play such a vital role in caring for these moms, and they're very complex — their mental health, ongoing conditions.
And, you know, for our moms, there is treatment, right? There's opioid use disorder medication treatment. There's other behavioral therapy interventions that, you know, for stimulant use disorders. There's treatments for alcohol use and tobacco, et cetera.
And so, you know, our goal is really to just improve outcomes — not just for mom, but for baby, for families, for communities.
If you're able to keep families together and people are stable and sober and getting care and receiving treatment long term, like, they have amazing, incredible transformations.
And I think you know we need to reframe our idea of what it means to care for mom, it's caring for the community.
