UK program helps pregnant women overcome opioid-use disorder

Gabi Espinosa and Ashlee Vogelsang at the Polk-Dalton Clinic (University of Kentucky photo by Mark Cornelison)
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By Dani Jaffe
University of Kentucky

For expectant mothers, the top priority is to do everything in their power to ensure their baby arrives healthy. For some women, this task is harder than it sounds. In Kentucky, 20 out of every 1,000 babies are born to a mother who is using opioids — the third-highest rate in the country.

Two women who have been through this experience are Ashlee Vogelsang and Gabi Espinosa. Both underwent treatment in UK HealthCare’s Perinatal Assistance and Treatment Home (PATHways) program, housed within UK’s Polk-Dalton Clinic. This program is designed to help pregnant people who are living with substance-use disorders.

Vogelsang lived with opioid use disorder for 13 years. The final time she got in trouble with the law for using drugs was also the moment she found out she was pregnant. She was given no other choice but to seek treatment at The Chrysalis House and enter PATHways for prenatal care — a program that helped save her life.

She was first put into PATHways for traditional treatment and was referred for additional support from its Birth and Recovery Integrating Group Holistic Treatment program. BRIGHT is a woman-centered group treatment program led by a midwife, which meets every Friday for treatment and counseling with a therapist, nursing support and peer support staff.

Her first moments in BRIGHT were filled with fear and anxiety for what was to come, but that soon faded when she realized that she did not have to go through it by herself – a whole staff, support group and midwife were there to help her.

“You don’t know what to expect. But when you come in and have a group of women who all are going through the same thing you are, that just kind of takes away all the fear,” Vogelsang recalled. “It gives you that feeling of not being alone. We’re all there. We’re all pregnant. We’re all trying to recover. You can commiserate with other people, and it just gives you that feeling that it’s going to be OK.”

Studies show that being surrounded by a support system of other expecting mothers and a midwife for woman-centered care can make a world of a difference. In fact, midwifery care has been shown to decrease intervention when in labor, improve patient satisfaction and reduce preterm labor rates.

While Vogelsang had no choice but to enter the program, when she was in recovery and found out she was pregnant again, she instantly knew that she wanted to re-enter BRIGHT, this time on her own terms.

“I came back willingly for my second pregnancy in recovery because I know how much I gained the first time,” she said. “I was excited to be there because I knew there would be girls like my friend Gabi that were new to this, and I’d be able to help them through the process because I had already been through this once.”

Today, because of her hard work, dedication and the support she received through PATHways, Vogelsang is a stay-at-home mom, homeschooling her two teenage children and caring for her two little ones, all while furthering her own education at UK.

“I wouldn’t be where I am today, almost four years sober, if it wasn’t for the PATHways group believing in me every step of the way,” she said. “I lived with these people. We all came in different parts, but we came as one person. We all were there for the same end goal. They’re like sisters now.”

And in the future, she would not hesitate to go back again, as she attributes much of her success to the women that helped her through both pregnancies.

“I just love the women at PATHways,” said Ashlee. “And I promise, when I do find myself ready to have another baby, PATHways is where you will find me.”

Gabi Espinosa and her fiancé dreamed of having a family but first wanted to seek treatment and stability. They started on the right track, found themselves in a better home and began treatment on Suboxone, one of three effective medications used to treat opioid-use disorder. But when Gabi found out they were expecting, she knew that she wanted some additional support to help her through the pregnancy. That is how she found PATHways and BRIGHT.

One of the best things about the BRIGHT program for Espinosa is the sense of security it gave her during her pregnancy.

“Going into the BRIGHT program, I was able to see certain people all the time and it stayed consistent. Having to see a whole bunch of different people and doctors can be nerve-wracking, and I don’t feel like that’s very good when you’re in recovery,” she said. “It gives you that trust and lessens your uncertainty because you’re next to women who are all going through the same thing.”

A common misconception about medication for opioid-use disorder is that it’s simply “replacing one drug for another.” OUD is a disease of the brain, not a lack of willpower, and withdrawal from opioids can cause debilitating side effects. Medications for opioid use disorder act on opioid receptors in the brain to both reduce cravings and the effects of illicitly used opioids – in other words, if a person uses opioids while on medication, the euphoria or “high” that usually comes with using the drug will be blocked. Studies show that the vast majority of people who attempt to stop using opioids “cold turkey” or stop medication treatment after a few weeks or months are very likely to relapse.

For pregnant women, having continual access to their medication is a key elements to the program’s success. To date, there have been no overdose deaths in women who are active in the program and using medication.

In the BRIGHT program, the use of a midwife to provide woman-centered care can also help with another hurdle: overcoming the stigma that pregnant women with substance use disorders face with mislabeling and misinformation about them as people, and as mothers.

“I was always worried about how people would see you being in recovery or being on Suboxone while you’re pregnant,” Espinosa said. “But I had all of them to support me, and people don’t look at you the way you think they might. You’re doing what you’re supposed to do for the sake of your child, and you’re a person just like everyone else.”

And like Vogelsang, Espinosa found the group environment BRIGHT provides to be very helpful in overcoming some of her greatest fears during pregnancy.

“I was terrified about how it would go at the hospital. But I wasn’t as terrified when I got to the program, because all the other girls were there with me and I was able to see them have their babies and everything was completely fine,” said Gabi. “That’s what helped put my mind at ease.”

Their partnership between UK, its College of Nursing, and the state Cabinet for Health and Family Services has helped provide treatment to hundreds of other mothers like Espinosa and Vogelsang.

Espinosa said she has looked up to many of the other strong mothers in her program. Seeing them have success and overcome struggles helped her through the most challenging times she faced, and now she hopes to be an inspiration to others as well.

“Now, my fiancé and I are in a beautiful two-bedroom apartment with our baby girl, and we look forward to expanding our family,” she said. “It’s crazy to see how far you’ve come. I know someone is probably looking up to me and it’s hard to believe that sometimes. If I could say one thing to the other women entering the clinic, I would say never give up, and never feel like you’re alone. There are so many people here to back you up. You can do this.”

If you or someone you know is pregnant and dealing with substance use disorder, contact the Polk-Dalton Clinic at (859) 218-6165 to make an appointment for prenatal care.