CINCINNATI -- The way Heather Fox’s newborn sleeps effortlessly in her arms makes it hard to believe the 2-week-old was exposed to heroin before she was born.
Fox said her baby experienced symptoms as a result of the exposure, but they weren't severe. Now a recovering heroin addict, she said she was able to stop using the drug during her pregnancy with the help of the HOPE Program at TriHealth.
The initiative -- one of the first of its kind in the Greater Cincinnati area -- aims to decrease the number of babies born into the heroin epidemic.
HOPE Program Director Dr. Michael Marcotte said opiate-addicted pregnant women come to Good Samaritan Hospital with aspirations of getting into the program.
HOPE -- which stands for Helping Opiate-addicted Pregnant Women Evolve -- has served more than 500 women and children over the last three years. Of those women, Marcotte estimates 80 to 85 percent maintain sobriety.
Fox and her daughter, Luna, are on track to be the program’s latest success story.
“She’s my world,” Fox said. “Before, heroin was my world -- my world revolved around heroin, and now my whole world revolves around her.”
‘I was at a breaking point’
The 32-year-old found out she was pregnant in March. She said she tried to get methadone to curb her cravings, but she would use heroin the days she couldn't afford it.
Like a lot of people who face opiate addiction, Fox didn’t know where to turn for help. And that’s hardly the only obstacle. Fox didn’t have medical insurance, and she said most facilities have waiting lists that stretch for months.
“I was at a breaking point,” Fox said. “I wanted so bad to do the right thing ... I just felt really hopeless because I felt there was nothing I could do and no place to help me.”
She said April 17 was the last day she used heroin. The next day, she traveled to Good Samaritan Hospital from Columbus to receive prenatal care before she entered the program.
“When I went to the hospital ... everybody treated me like a normal person, and I didn’t feel like they were treating me like some drug addict,” Fox said. "That right there in itself was one of the biggest reasons why I felt accepted.”
The story of Fox’s opiate addiction is one that seems all too familiar. She said doctors prescribed her pain pills for a congenital kidney defect when she was a teenager. When she was 27, she said she realized heroin was cheap, readily available and would satisfy her addiction.
Fox said she used to think about heroin before her feet hit the floor in the morning.
“The first thing on my mind when I would get out of bed is, ‘Oh my God – how do I get money to get drugs to be halfway normal today,’" she said.
She said she switched to the needle after smoking heroin every day for two years, and she injected heroin -- something she had sworn she’d never do -- for another two years until she found the HOPE Program.
“If I wouldn’t have come here, I wouldn’t have (my baby),” Fox said. “I’m really happy that I came to the program and that I got clean -- that I had a chance to change my life and get to bring my baby home.”
Program ‘saved my life’
Fox lives at First Step Home, a treatment center that allows women to live with their children as they recover from their substance use disorder. First Step Home partners with the HOPE Program to give women the space and resources they need to maintain sobriety.
The program provides coping skills and therapy. They also offer classes for breastfeeding and parenting.
“I didn’t know how to have a normal life,” Fox said. “The HOPE program and First Step opened doors and gave me opportunities that I wouldn’t have had had I not come here.”
First Step Home and the HOPE program help women get medical insurance, find housing and look for educational or employment opportunities. First Step Home also gave Fox a stroller, car seat and clothes for little Luna.
“Coming here, it wasn’t just about getting sober," she said. "It was about what caused me to want to use to begin with.”
For Fox, it was about escape. She said she used to forget her past, mask her problems and stifle her emotions.
Fox has developed healthy coping mechanisms. She said she's learned how to process her feelings. Her counselor helps her with trauma therapy, and she’s taken several courses -- from parenting to relapse prevention.
“These are things I didn’t know I needed,” she said. “I didn’t know that my past was affecting my present so much.”
Now, Fox said she hopes to be a part of the solution.
“These babies are our future. They don’t deserve that. They don’t deserve being born into the world addicted to drugs," she said. "Who knows what the long term effect will be on them?”
A new unit for babies experiencing withdrawal
In 2016, about 19 percent of babies in the HOPE Program had to go to the neonatal intensive care unit because of withdrawal symptoms that required pharmacologic care, according to Marcotte. That does not include the newborns admitted to the NICU outside of the program.
The numbers pose a unique problem for hospitals. Not only do babies experiencing withdrawal take up beds in the Neonatal Intensive Care Unit -- or NICU -- but that environment isn’t conducive for the specialized attention the newborn needs, Marcotte said.
Last year, 35 of the babies born into the HOPE Program were admitted to the NICU to be treated for neonatal abstinence syndrome.
“We’re trying to decrease that,” he said. “We’re trying to change that by helping upstream with these moms before they deliver their babies because it definitely improves the chances that the baby won’t have to come to the NICU.”
Babies born with opiates in their systems need a quiet environment with as little stimulation as possible, Marcotte said. The newborns need round-the-clock care, whether it be cuddling, swaddling or nurturing.
“We can actually sometimes avoid giving them medication to treat their withdrawal just by giving them these non-pharmacologic treatments,” he said.
That’s one reason Marcotte said he is spearheading plans to create a special wing at Good Samaritan for babies born with opiates in their systems.
“Since we are really on the front edge of trying to figure out what’s best in trying to care for these moms and babies, why not build the best for them,” he said.
Tracking cases of NAS is complex. The Ohio Department of Health statistics reflect all infants coded for neonatal abstinence syndrome. The Tri-State only measures the newborns who require pharmacologic treatment, according to Dr. Scott Wexelblatt, the regional medical director for newborn services at Cincinnati Children’s Hospital Medical Center.
There’s no timeline on when the wing will be completed, but Marcotte said TriHealth is on board with the idea.
“We have the partners ready to jump in and really start providing that care,” he said. “We have some amazing nursing staff here in the NICU who have developed an expertise at knowing who to care for babies who have this syndrome.”
The numbers back up the need. In a typical week, Marcotte said five to 10 women deliver babies who have opiate use disorders. Of those babies, two of them will have to be admitted to the NICU for treatment, he said.
Fox said she feels very fortunate her daughter didn’t have to stay in the NICU.
“This is something we can prevent,” Fox said. “I would hope more women who are pregnant and using realize they need to get help and that there is help.”
Fox said she looks forward now to having a normal life and enjoying routine things.
She’s excited about the idea of going back to school. She can’t wait for meals around the dinner table, cake at birthdays and opening presents on Christmas day.
“I hope that other women can realize that their lives are worth fighting for -- their kids are worth fighting for,” she said.