PREGNANCY IS A DIFFICULT JOURNEY under the best of circumstances, with many factors influencing the likelihood of a healthy birth. For women with a high-risk pregnancy complicated by substance use, that journey can be especially challenging—and its outcome even more uncertain.
Recognizing that expectant moms battling addiction often need additional resources, services, and support in order to bring a healthy baby into the world, Mercy Health launched the New Beginnings program at Mercy Health – Franklin Avenue Obstetrics & Gynecology in January of 2021.
New Beginnings, part of the Healthy State Alliance, a collaboration between The Ohio State University Wexner Medical Center and Mercy Health, was created for the purpose of tackling Ohio’s most critical health needs and making a difference in improving the overall health of communities.
The team of expert professionals who comprise New Beginnings includes James Kiyak, MD, and Christopher Benavente, DO, both attending OB/GYN providers at Franklin Avenue Obstetrics & Gynecology; Sandy Kiyak, RN, Perinatal Care Coordinator at Mercy Health – Franklin Avenue Obstetrics & Gynecology, and Clinical Care Coordinator for New Beginnings; licensed social worker Krystal Hughes; Abbi Bellas and Natalie Speweik, both social workers with the Mother and Child Dependency Program; as well as various ancillary staff members and community partner organizations.
“Our goal for New Beginnings patients is the same as the goal for all our obstetric patients—to guide them to the birth of a healthy baby,” Sandy Kiyak says. “What’s different is that New Beginnings provides extra support and access to complete wrap-around services that address the issues and concerns specific to this patient population.”
The program provides care that extends from pregnancy to delivery and up to six weeks postpartum, as well as access to breastfeeding support, weekly group support sessions, medication-assisted treatment options, behavioral health services, addiction services, and social services. However, New Beginnings is not a drug-treatment or detox program. Patients requiring those services will be referred to other community programs.
The support group component, which focuses on making lifestyle changes to prevent relapse, is especially beneficial to New Beginnings participants. “Our moms meet once a week for group sessions at the clinic, where they have the opportunity to share experiences, stories, and encouragement. That high level of moral support from peers and professionals is vital in confronting the challenges of pregnancy, substance use, and other stressors in their lives,” states Sandy Kiyak.
Mother and Child Dependency Program social workers Abbi Bellas and Natalie Speweik, who are funded by a grant to assist pregnant women with any substance-use disorder who are residents of Lucas County, also play an indispensable role in New Beginnings. Similar to caseworkers, they assist and advocate for participants in a myriad of ways, linking them to services and resources both in the program and in the community, arranging transportation, scheduling appointments, assisting in the transition from inpatient to residential settings, addressing social determinants of health, and much more. “We work very closely together with these two wonderful people to provide the clinical and social work pieces. I can’t say enough about their key role in the success of this program,” states Dr. Kiyak.
Perhaps not surprising, a major focus of the New Beginnings team is the ongoing epidemic of opioid use and its impact on the patients in their care, including the potential for Neonatal Abstinence Syndrome (NAS), which can occur in the infants of mothers who took opioids during pregnancy. Infants with NAS typically experience withdrawal symptoms in the first two to three days after birth but may exhibit signs lasting for weeks or months.
“Opioid use disorder continues to be a problem across the nation and locally, so there’s no question that there’s a need for these services in our community,” states Dr. Kiyak. “In fact, we know the problem has gotten worse nationally. In 2021, we saw a record number of deaths in the US from opioid overdose in all individuals and the number is expected to continue to rise this year.” Furthermore, according to the Centers for Disease Control and Prevention, the prevalence of opioid use disorder among women giving birth more than quadrupled between the years 1999 and 2014, from 1.5 per 1,000 to 6.5 per 1,000. The entire New Beginnings team
The entire New Beginnings team also strives to erase the stigma attached to substance-use disorder, which can prevent pregnant women who are struggling with addiction from seeking the care and resources they need. As Sandy Kiyak points out, “Every woman we care for is someone’s daughter, sister, granddaughter, wife, or friend, and she came here for help, not judgment. When our patients reach that point of understanding that their substance use is a disorder, not a problem related to some defect in their character, they become much more receptive to care.”
New Beginnings enrolled 12 women in 2021, and four women have enrolled in the program thus far in 2022. Three women have “graduated” the program—meaning they achieved a healthy pregnancy, delivery, and postpartum period—and three others are pending delivery.
“Looking to the future, we hope to reach more patients and continue to achieve outcomes of a healthy pregnancy for mothers and babies, reduced hospitalization in the neonatal intensive care unit, a reduced incidence of neonatal abstinence syndrome, and increased sobriety for the women in our care,” says Dr. Kiyak.
New Beginnings is located at Mercy Health – Franklin Avenue Obstetrics & Gynecology, 2213 Franklin Ave., Toledo, Ohio. For more information, please call Sandy Kiyak at 419-251-2412. ✲
