‘There are tragic stories behind these women’
Ottawa midwife Amy McGee has been known to meet pregnant women who are dependent on opioids almost anywhere. At home, on the street, in a coffee shop. Even in jail.
Most of her patients don’t have a family doctor. Many also don’t have a health card, and so have no way to access health care. They often need bus passes, a stable place to live and food security.
“The system is nearly impossible to navigate without support. There are so many ways to fall through the cracks,” says McGee, the outreach worker for ORACLE, a groundbreaking program out of The Ottawa Hospital that helps pregnant women who are dependent on opioids to get medical attention — and, where possible, to bring their babies home.
Typically, these are women who, in the past, might have shown up at the hospital in labour without getting any prenatal care at all, often because they fear their babies will be apprehended by child-welfare at birth, says Dr. Laura Gaudet, a researcher at the hospital and an associate professor in obstetrics and gynecology at the University of Ottawa. Among other organizations, the program has links and partnerships with the Royal Ottawa Mental Health Centre, the Centretown Community Health Centre as well as shelters, the methadone clinic, the jail, Ottawa Public Health and the Ottawa Children’s Aid Society.
“There are tragic stories behind these women,” says Gaudet. “They are all desperate to be good moms. They can tell stories about how their own moms failed them. They almost all ask for their mothers to come when they’re in labour. The moms rarely show up.”
Opioid-dependent pregnant women have long been a chronic frustration for health-care providers because they are wary of doctors and hospitals, says Gaudet. “We would make an appointment, and they wouldn’t come. Sometimes they would just show up in emergency in labour.”
ORACLE (the acronym stands for the rather convoluted “Ottawa out ReACh perinataL carE)” started as a one-year pilot project. It’s now in its second year, with plans to expand from the Civic campus to the General campus.
The number of pregnant women coming to the program who are dependent on opioids is rising. But it’s unclear if there’s an increase in the number of opioid-dependent pregnant women in Ottawa, or simply in the numbers being directed to the program, says Gaudet. ORACLE clients include users of stimulants, alcohol, crack cocaine and those with mental health issues without substance abuse. She estimates that two out of three women who use the program use opioids.
“On the obstetrics side, we see more and more addicted women. Young women are a vulnerable side of this epidemic. In the past, they would show up with abdominal pains and never even know that they were pregnant,” says Dr. Mark Walker, the hospital’s chief of obstetrics, gynecology and newborn care. “We were looking after these patients before, but we didn’t have the outreach.”
ORACLE uses a harm-reduction model and doesn’t expect abstinence from the women in the program. McGee, who is one of the founding partners of Community Midwives of Ottawa, as well as being a social worker with a PhD in addictions, collaborates with clients to find ways to reduce the harms of substance use.
“For example, for smoking cigarettes, that could include going outside to smoke, washing the chemicals off your hands and face when you come inside. People are usually quite open to changing the way they use, even if they aren’t considering decreasing the amount they are using.”
Pregnancy is major transition time. Many people re-evaluate their diet, how much they exercise, minimize smoking and drink less, she says. “It’s easy to forget that alcohol is substance use, when it is regular evening consumption. We have normalized the use of some substances and punish people for using others. There is a real case to be made for decriminalization.”
The mothers are encouraged to call Children’s Aid on their own. Sometimes a report is unavoidable, because, for example, earlier children are in care or there was active substance use in pregnancy. “It’s better to call and get it over with,” McGee says.
Keeping mother and baby together has benefits, says Gaudet. “When their baby is taken away, these women just leave the hospital and resume use immediately. Even someone with a really chaotic drug problem really loves their baby,” she says.
The cost of a child being in care for their entire life is significant. It includes not just the cost of foster care and the annual budget of the Children’s Aid Society, but also court costs and income supports. Meanwhile, there’s a disproportionate burden of child-welfare involvement on Indigenous people, says McGee, who has worked as a midwife in Indigenous communities in northern Ontario and Quebec. The cost is not just to society, but to families.
“The parents that I work with love their children, their faces light up when they see their children, their babies. Kids that grow up shuffled around, whose bond has been broken with the person, with the parent whose eyes light up, may never find anybody that cares for them in the same way,” she says.
Statistics about the program are being collected. Walker believes it’s important not only to look at the need for the program, but also the outcomes.
“One of the things I would like to do is look at how these women are doing at turning their lives around,” says Walker. “I think we’re setting them up for success, but I don’t think we have the data that shows that.”