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County telling pregnant women to put down that glass of wine
Topics: Kern Medical Center, Sudhir Patel, OB/GYN, Clinica Sierra Vista, National Health Services, Child Protective Services.
Posted by RaisingBakersfield Mon Apr 28, 2008 19:02:22 PDT
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The county's new initiative to verbally screen pregnant women for drug, alcohol and tobacco use isn't aimed at the stereotypical drug-addicted mom-to-be.

It's aimed at the casual users, the white, college-educated expectant mother who might occasionally smoke or drink.

It’s aimed at women like Nikki Garcia.

Garcia, 38, walked through the Marketplace with her mother on a recent Wednesday afternoon.

“It’s your life,” the Bakersfield mother said. “I think if you have a glass of wine every once in awhile, it’s OK.”

Called Perinatal SART — screening, assessment, referral and treatment — the program educates physicians to ask pregnant women “gender-appropriate” questions about drug use and discuss with them the risks to the baby.

The program emphasizes that there’s no safe amount.

“The safe level is zero,” said Dr. Sudhir Patel, chief of neonatology at Kern Medical Center and director of neonatology at Mercy Southwest Hospital. “The risk is there.”

So far, Kern Medical Center, Clinica Sierra Vista, National Health Services and some private practitioners are on board with the program, but Patel wants to expand it to every OB/GYN in town.

How it works

A fetus’s brain begins developing the third week of pregnancy, said Dr. c, deputy health officer and director of several maternal-child programs at county public health. So it’s important that woman see their OB/GYN soon as possible after conception.

Once in the doctor’s office, the staff will ask patients about their parents’ and partner’s drug use, along with their past or present use.

“Whenever the woman can stop, there’s going to be improvement in the child,” Choi said.

If the physician or nurse feels that there is a risk, the woman is asked more questions to gauge the type and level of exposure, said Patel, who is on the leadership group behind the initiative. A brief intervention is done, in which the potential complications from using the substances are explained.

The physicians might also refer some women to other agencies for help, but 95 percent of the time that’s not necessary, he said.

“That’s the amazing thing,” he said. “If you spend some time and you educate the women, then and there, that in itself decreases continued exposure better than anything else we can find.”

The physician is instructed to ask the women questions in a nonconfrontational way.

“This list of questions and the tool that we’re using is not new,” Patel said. The difference is that this tool is made for women.

“Almost every tool we use has been designed for a man,” including the standard one-line “Do you use drugs?” questions most pregnant women are asked, he said.

The questions are asked in a different tone, “not trying to find out some secret that will take the baby away,” Patel said.

Fear of persecution

By using a different approach, the initiative’s advocates hope to get around one of the biggest fears mothers face: having their babies taken away.

“It’s not that we want to turn people over to the law. In fact, we don’t want to do that,” Patel said. “They think that if they tell us the truth, they will get in a lot of trouble.”

Even if a pregnant woman is abusing drugs, the physician cannot legally break patient confidentiality and report her, said Heidi Carter Escudero, communications director with the county human services department, which oversees Child Protective Services.

“Mandated reporting is the only thing that comes between confidentiality and the patient,” she said. “A child does not exist yet, legally speaking, so there is no mandatory reporting.”

And even after the child is born, Child Protective Services won’t automatically take the baby away if the mother has a substance abuse problem, said Linda Erb, Comprehensive Perinatal Services Program coordinator for the county.

“If a woman shows that she’s doing something about it, that she’s been screened and has been referred, CPS isn’t going to walk in and take the baby,” Erb said.

Still, Carter Escudero stressed the importance of a drug-free pregnancy.

“You can never predict at what point other people will get involved in your life,” she said. “You do have a right to privacy, but your children have a right to a safe and healthy environment.”

On the coast

The program is based on the work of Dr. Ira Chasnoff, a Chicago-based expert who has started the program in several states and several counties in California.

One of those is San Luis Obispo.

“Our choice of drug here in San Luis is alcohol. We are smack in the middle of wine country,” said Jan Campbell, the county’s maternal, child and adolescent health director. “We have physicians in our county who say it is OK to drink moderately.”

An obstacle for San Luis Obispo has been getting doctors to participate.

“A lot of doctors don’t want to think that they have women who are using,” Campbell said. “But it’s not the hard-core drug users we are targeting.”

According to her group’s Web site, of the roughly 2,600 deliveries per year in San Luis Obispo County, 1,305 women were screened at their first prenatal visit in 2004.

Among these women, 42 percent had used alcohol or tobacco during early pregnancy.

“We were absolutely shocked with what we found,” she said.

Other opinions

Kern County’s Kaiser Permanente, the largest medical group in the county, said, “Thanks but no thanks,” to the initiative.

“We support what the Perinatal SART program is trying to accomplish,” said spokeswoman Natalie Erlendson. “But it wouldn’t make sense for us.”

Kaiser doesn’t approve of any alcohol or drugs during pregnancy, she said.

Plus Kaiser already asks patients about use, along with depression, said Heidi Priest, registered nurse in Kaiser’s perinatal services.

“I don’t find that most of them hide the information,” Priest said. “We have several patients who admit to using drugs, and we just get them hooked up with the resources we have.”

San Dimas Medical Group, the county’s largest OB/GYN group, also disapproves of any alcohol, tobacco or drugs during pregnancy, said Dr. Jigisha Upadhyaya, an OB/GYN and medical director of the group.

Patel has talked to the group about the program and will soon be training its doctors, she said. But she’s concerned that there’s not enough resources to refer women to if they need extra help.

“As a doctor you want to diagnose the problem, treat it and win,” Upadhyaya said. “That’s one link that’s missing in the program.”

Kern Mental Health is taking part in the initiative, Patel said.

The county has enough counselors and resources; what’s lacking is a directory to give physicians, he said. The group behind the initiative hopes to have that in the next year, along with an educational conference.

Katie Moyes, 24, said she’s heard of several alcohol and pregnancy old wives’ tales but wouldn’t follow any of them.

“Women feel intense pressure; they feel stressed and want to let loose,” said Moyes, who has no children. “But all of that’s going into your child’s body.

“If you’re going to be responsible for a life, then you need to respect that life.”

Effects of drinking alcohol

• There is no known amount of alcohol that is safe to drink while pregnant

• Drinking alcohol during pregnancy can cause many birth defects and developmental disabilities, which are known as fetal alcohol spectrum disorders. These can cause problems in how a person looks, grows, thinks and acts. They can also cause birth defects of the heart, brain and other major organs.

• Alcohol can harm a baby at any time during pregnancy, including the early weeks of pregnancy before a woman even knows she is pregnant.

Effects of smoking on babies

• Babies born to mothers who smoked during pregnancy have about 30 percent higher odds of being born prematurely.

• They are more likely to be born at a low birth weight, which is below 5.5 pounds, increasing their risk for illness or death.

• They are 1.4 to three times more likely to die of sudden infant death syndrome.

Effects of smoking on pregnant women

• Women who smoke prior to pregnancy are about twice as likely to experience a delay in conception and have about 30 percent higher odds of being infertile.

• They are also about twice as likely to experience premature rupture of membranes, placental abruption and placenta previa, which is when the placenta implants in the lower part of the uterus.

• Pregnant women who are exposed to secondhand smoke have 20 percent higher odds of giving birth to a low birth weight baby than women who are not exposed.

Source: Centers for Disease Control and Prevention

Alcohol statistics

• About 19 percent of women who gave birth reported drinking during the first or last three months of pregnancy.

• Women with incomes over 400 percent of the federal poverty level, which is $68,680 for a family of three, were twice as likely as the poorest women to drink during the first three months of pregnancy.

• These same women were five times as likely to drink alcohol as the poorest women during the last three months of pregnancy.

• Women who had at least a college degree reported the highest rates of drinking alcohol during the first and third trimesters.

• White, non-Latina women reported the highest rate of drinking alcohol during pregnancy.

• Women 35 years and older had the highest rates of drinking in both the first and third trimesters.

Source: 2003 Maternal and Infant Health Assessment, a collaborative project between the state Department of Public Health and the University of California, San Francisco

Smoking statistics

• Smoking was the most prevalent in black and white women, at about 15 percent.

• Women in higher-income families were three times less likely to smoke during pregnancy, compared to women in low-income families.

• Pregnant women ages 15-24 had the highest rates of smoking, at about 13 percent.

• Almost twice as many women smoked when they got their first prenatal care during the second or third trimesters, compared to the women who got care during the first trimester.

Source: 2000, 2003 Maternal and Infant Health Assessment, a collaborative project between the state Department of Public Health and the University of California, San Francisco

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Source: The Bakersfield Californian, Tuesday, Nov 13 2007

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