For a long time, women in Oregon who were both pregnant and fighting addiction were caught in a Catch-22. Addiction providers didn’t want to work with pregnant women because of potential complications. And maternity care providers didn’t want to work with women suffering from addiction because of lack of understanding and expertise in that area.
What were they to do?
The answer arrived in 2014 when Project Nurture was launched. It’s a care model that integrates substance use treatment and maternity care.
“The program was created because there was a gap in the system,” says Maggie Bennington-Davis, the group’s CEO and Chief Medical Director.
“For many women who are addicted, often the first time we saw them was at the hospital at the time of delivery. They avoided doctors and received no prenatal care. That led to complicated deliveries, premature babies and high-level care.”
Now Project Nurture provides a positive alternative. Its goals include engaging and building trust; improving health and reducing costs; breaking intergenerational cycles of trauma; and building the workforce.
Each of the project’s three sites is based on a partnership model. They all have a support group available to women at every stage of their pregnancy. Each site is different by design.
Legacy/Lifeworks is based in a midwifery clinic with peers while Lifeworks provides addiction treatment. Providence Milwaukie is an OBGYN-based program. Providence Behavioral Health staff provide substance use treatment and mental health support. MAT with buprenorphine is available on-site. Deliveries occur at Providence Portland. And CODA/OHSU has OHSU Family Medicine providing maternity and pediatric care. Deliveries are made at OHSU. MAT with methadone is provided on-site. Doula care is provided for up to one year after birth.
The program has a robust outreach strategy and women come to it in different ways. There are referrals including from the Department of Human Services. “Oregon is a small town in many ways,” Bennington-Davis points out. “We work with them in keeping infants and moms together. They help us identify people as well. And we use a lot of peer to peer support, along with outreach in communities.”
The program is available regardless of substance, though Bennington-Davis says it tends to do better with opioid use disorder, and offers non-judgmental, low barrier access to care. “Even if a woman doesn’t want recovery, that’s ok. All women are welcome even if they don’t continue with treatment after the birth of their child.”
So far, care has been provided to more than 300 women. The program has reduced odds of preterm birth by 170 percent. And 93 percent of women who complete the program successfully parent their babies through the first year. Additionally, infants had 50 percent reduced odds of needing a higher level of care at birth.
One woman who participated in Project Nurture sums it up this way.
“I don’t feel like I’m coming to a therapy session. I do feel like I’m coming to a group. I’m uniting with other people like I’m part of something.”
Project Nurture was a featured award winner in the 2019 Innovation Now project of the Addiction Policy Forum.