As opioid crisis deepens, so does work with pregnant people in throes of addiction
Dr. Laura Lyons has been working with people in crisis who are pregnant since 2005
Dr. Laura Lyons has seen the city's opioid crisis change and deepen from a vantage point that's different than most: the delivery room.
When she first started working with pregnant women facing mental health crisis and addiction two decades ago, about 20 babies a year were delivered suffering from drug withdrawal symptoms. This year, that number is about 50.
"We're seeing much higher incidents of overdose and toxicity than we did back in 2005. The severity of the substances that are being used, the lethality of those substances and the volume of those substances have changed dramatically," Lyons said in an office where she works as a family doctor.
"We've also seen the complexity of the social issues grow. Infectious disease, homelessness, food scarcity — we're at a major crisis point."
Lyons is an addiction medicine specialist who works in perinatal addictions, focusing on people who are pregnant and parenting young children, and who need her help.
'Eat, sleep, console'
At any point in London there are around 30 women struggling with addictions that are pregnant, Lyons said.
In the past 20 years, doctors and nurses have become better equipped to help babies born with withdrawal symptoms, which can include tremors, high-pitched crying, and trouble sleeping and eating. The doses of morphine given to help the babies aren't as high as they used to be, Lyons said, and there's an emphasis on skin-to-skin contact and physical touch from parents.
"We monitor the babies under the eat, sleep, console protocol. We monitor them to make sure they can suck and swallow to get the nourishment they need, that they can sleep for a period of time, even an hour, and whether they can be consoled with skin-to-skin and in quiet environments," she said.
"That minimizes the number of babies that need to go into the neo-natal intensive care unit and the babies that need medication in order to manage those withdrawal symptoms."
Lyons treats people through a clinic at the London InterCommunity Health Centre, some who come for help and others who are referred to her from encampments or shelters. She also works at the London Health Sciences Centre in its obstetrics department and as a family doctor on Platt's Lane.
Often, people in crisis or living with addiction haven't had good interaction with the health care system, so the InterCommunity Health Centre has opened a new obstetrics clinic that means pregnant people don't have to go to the hospital to get care.
"The people we serve don't typically access health care in the traditional way, due to a number of barriers such as homelessness, mental health, and other hardships," said Greg Nash, the clinic's director of program development and complex urban health. "To change that, we are partnering differently and using the trust we have already established to bring these pregnant individuals to this new clinic, to ensure they get the obstetrics care they need."
Two ultra sound machines allow patients to be treated right in the Dundas Street clinic, Lyons said.
"It's quite a different population in terms of social and psychological complexities," she said. "There's a lot of social determinants of health that are affecting these people. Living rough, with food scarcity, it just compounds mental health issues. What we're trying to do is not just treat the well-being of the mother but the wellbeing of the child."
Gaps remain
There are no programs that enable moms and babies to stay together after the hospital while transitioning into recovery in a safe, supportive environment. Those kinds of programs exist in British Columbia and Alberta, Lyons said, and would be transformational for young families here.
"London really needs that supportive service for those mothers, so that child and parent bond can continue to grow," she said.
"In Vancouver, there's a postpartum unit actually in the hospital, staffed by nurses 24-hours a day, and they have the supportive services so that babies and moms are there in the postpartum period, getting the medications they need but not in the neonatal intensive care unit but with their moms," Lyons said.
"There [are] nurses and doctors in house, but also social services, addiction recovery programs, mental health programs, and women stay there an average of 70 days until they're stabilized and can organize housing."
The lack of affordable housing here in London has made things very difficult for postpartum women, Lyons said. "We won't send them back to the street, so we've had prolonged admissions for women who lack housing while social workers are pulling out all the stops to find beds for them."
ABOUT THE AUTHOR
