Every Monday, a mini fridge is filled with snacks and sandwiches at a drop-in clinic in downtown Toronto for people who use substances during pregnancy.
Called My Baby and Me, the clinic at St. Michael’s Hospital began in its current form in 2021. No appointment or referral is needed. Individuals can drop by and have something to eat, and they also have the option to see the care team.
Erin Lurie, a family and addictions medicine physician who leads the clinic, says individuals can receive care for their pregnancy, such as blood work and ultrasounds, as well as supports for their substance use, such as prescriptions for suboxone or methadone, and for the postpartum period. The clinic considers psychosocial needs and any concurrent illnesses, she said.
Jasmine Saleh, the clinic’s social worker, says she is most focused on fostering trust in relationships with those who visit the clinic. Many individuals, she said, had negative health care experiences in the past and say disclosing substance use during pregnancy is highly stigmatized. “I let folks know that this is a safe place,” Ms. Saleh said. “We really take their lead.”
A leading cause of maternal death in Canada is overdose. Physicians and health care workers are also concerned about the physical effects of withdrawal. They say wraparound supports for individuals who use substances during pregnancy and postpartum are critical and need to be scaled up amid the toxic drug crisis. They point to an unpredictable supply, including the increased presence of benzodiazepines and xylazine, an animal tranquillizer, being cut into drugs like fentanyl.
A study published in the Journal of Obstetrics and Gynaecology Canada this year reviewed maternal deaths by suicide and drug overdose in Ontario and B.C. across different age groups and the pregnancy-postpartum period.
What to know about Canada’s toxic drug crisis and supervised drug-use sites
The researchers concluded these factors may contribute more to maternal deaths than previously thought and that there is a need for programs to identify at-risk women and to intervene during pregnancy and beyond the traditional postpartum period.
Heather Watson, a psychosocial obstetrician gynecologist who speaks about opioid use and pregnancy for the Society of Obstetricians and Gynaecologists, said there has been an escalation in opioid-affected pregnancies over the past decade. She said it is “absolutely a national crisis.”
Dr. Watson is part of a perinatal team at the Health Sciences Centre Winnipeg, which offers a range of care, including psychiatry and psychology, social work, midwifery and dietitian support. She said having “lots of spokes in the wheel” allows the team to examine not only what is happening with a pregnancy, but factors such as home life and patient safety.
She said these teams are valuable investments that not only save lives but improve communities.
However, access to care is still a major barrier: Many parts of Canada, especially in rural and remote areas, do not have, or have few, services designed for people who are pregnant or parenting while using substances.
This summer in British Columbia, in response to that concern, a perinatal stream was added to the Northern Health Authority’s virtual substance-use clinic. Northern Health is the province’s largest geographic health region, serving 87 communities, 55 of which are First Nations. Vanessa Kinch, the service’s mental-health and substance-use nurse, said the goal is to connect patients to local supports and reduce strain on larger centres.
The province is also home to a long-standing program at the B.C. Women’s Hospital and Health Centre that has, for more than 20 years, provided specialized support to pregnant people who use substances.
The Families in Recovery program assists patients from pregnancy through to postpartum and beyond, explained Darci Skiber, executive director of the hospital’s mental-health and substance-use programs.
She said a “unicorn work force” trained in obstetrics, primary care and addiction medicine is joined by a large non-medical team that helps with other supports, such as housing. Mothers and their newborns are provided assistance to stabilize and withdraw from substances, in addition to counselling and life-skills training in a non-judgmental, trauma-informed environment.
One of its defining features is the rooming-in unit where mothers and their newborns stay in the same room to enhance bonding through skin-to-skin contact, which has been proven to reduce the need for medication to treat neonatal withdrawal syndrome. About 90 patients are seen yearly in the FIR program, staying on average for 70 days.
Dr. Skiber added that there have been “quite astronomical” changes in the complexity of patients over the past two decades. “There are mental-health concerns, there’s substance-use concerns and then there’s also brain injury as a result of multiple overdose events,” she said.
In Alberta, a research team is working to develop rooming-in programs in six additional hospitals across the province, building on efforts at existing sites in Edmonton and Red Deer.
Deborah McNeil, an adjunct associate professor in the department of community health sciences at the University of Calgary, said an estimated 300 babies are born each year in Alberta with neonatal withdrawal syndrome but this figure could be higher considering rapid population growth.
She said babies born with this syndrome are difficult to care for as they suffer from irritability, diarrhea, tremors and are difficult to feed. She said that studies have shown, however, that the parent is “medicine for the baby.”
Funding for the study was secured in 2021 but, owing in part to COVID-19 difficulties and a purposely staggered implementation, all sites won’t be online until next year. Data will be collected from all eight sites to evaluate what conditions are required for effective implementation. The hope is that every Alberta hospital eventually houses this service.
Back in Toronto, Dr. Lurie said she views herself as her patients’ cheerleader, providing them with medical tools to achieve “success that they envision for themselves.” She’s lucky, she said, to be “along for the ride.”
