Expectant mothers with addictions to drugs or alcohol come to the Substance Abuse, Treatment, Education and Prevention Program (STEPP) for treatment. Part of The Ohio State University Wexner Medical Center’s Maternal Fetal Medicine practice, this weekly clinic is held every Wednesday morning and provides personalized, high-risk obstetric care, treatment and counseling.

Most women in STEPP have opiate addictions and participate in a treatment program (either inpatient or outpatient aligned with Ohio State’s Wexner Medical Center or through outside programs) as they work toward recovery. Additionally, our clinic cares for expectant mothers with infectious diseases, which are frequently, but not always, associated with illicit drug use.


Our Services

Controlled Medication

If you are dependent on opiates, including heroin, morphine, codeine, Oxycontin, Dilaudid, methadone and others, we can prescribe Suboxone®. This medication may help you have less severe withdrawal symptoms and make it easier for you to taper off as part of recovery. If you are prescribed this medication, you must participate in weekly substance abuse group-counseling therapy and see your prescribing physician weekly.

Counseling

If your care includes prescription-based medication stabilization, you are required to participate in weekly, hour-long group counseling sessions guided by a certified substance abuse counselor. Topics include issues specific to preparing for the birth of your baby and working toward recovery, including empowerment, self-esteem and relationships.

High-Risk Obstetrics

You’ll receive weekly intensive prenatal care, including a urine drug screen, obstetric exam, and discussions about medications, life stressors and other concerns. If needed, we’ll refer you to counselors and social workers.

Ultrasound

We’ll monitor your baby’s progress with high-frequency sound waves (no radiation), and state-of-the-art technologies. We’ll evaluate baby’s size, position and development as part of diagnosing developmental abnormalities.

Infectious Diseases

Because Hepatitis C and HIV are the two of the most common infectious diseases related to drug addiction, we collaborate with a team of Ohio State’s infectious disease physicians to coordinate any special care you may need during pregnancy. We also participate in NIH-funded research in conjunction with Nationwide Children’s Hospital to better understand Hepatitis C and pregnancy.

Newborn Care Planning

Together with neonatologists from Nationwide Children's Hospital NICU at Ohio State, we coordinate care to meet your baby’s special needs. Your baby is cared for during his or her own period of withdrawal, and receives treatment for any complications that may arise.

Why Choose Ohio State?

Managed by a maternal fetal medicine specialist in our high-risk obstetrics practice, the STEPP clinic program’s approach is to stabilize your drug use by replacing illicit drugs with managed, prescribed medications.

This treatment, combined with an emphasis on compassionate, nonjudgmental care, is designed to see you safely through pregnancy, delivery and follow up, including recommendations for continued rehabilitation or maintenance medication programs.

Because babies whose mothers abuse drugs and alcohol during pregnancy have higher risk factors for abnormalities, malformations, low birth weight and other complications, we place a special emphasis on providing comprehensive, thorough monitoring of moms and babies.

In close collaboration with an Ohio State pharmacist, and through personal interviews and observation, we are able to better manage the selection of your medications and dosage to help minimize acute phases of withdrawal.

In addition, we coordinate with the neonatologists at Nationwide Children's Neonatal Intensive Care Unit (NICU) at Ohio State's Wexner Medical Center to prepare for your baby’s care immediately after delivery. These specialists are experienced in providing compassionate care to babies in withdrawal, as well as addressing any special needs your baby may have.

Our Patients

Women who come to us voluntarily join the STEPP clinic, which typically cares for 30 expectant mothers at a time. Although we accept patients at any point in a pregnancy, most seek treatment before 24 weeks.

For those recovering from narcotic pain medication or opiate addiction, including heroin, morphine, codeine, Oxycontin, Dilaudid or methadone, our course of treatment includes medication stabilization as a component of care. This involves prescribing a controlled medication as a substitute for illicit drugs (to help patients avoid an acute withdrawal phase during pregnancy), and closely monitoring use of the medication. This approach reduces some of the risks that acute withdrawal may pose to baby.

Patients with alcohol or amphetamine addictions are encouraged to participate in 12-step programs for support as they abstain during their pregnancy.

Newborn Care for Babies with NAS

If you took any opioid medicines or drugs during your pregnancy, there is a chance that your baby may have withdrawal signs after birth, also called Neonatal Abstinence Syndrome (NAS). Most babies show signs in the first 48 to 72 hours after birth, but signs may last for weeks or months. Together with neonatologists from Nationwide Children's Hospital NICU at Ohio State, we coordinate care to meet your baby's special needs.

Symptoms of Withdrawal for Baby

Some of the main symptoms of withdrawal that your baby may have:  
  • Body shakes (tremors), seizures, overactive reflexes (twitching) and tight muscle tone
  • Fussiness, excessive crying or having a high-pitched cry 
  • Poor feeding, poor sucking or slow weight gain 
  • Fast breathing 
  • Fever, sweating or blotchy skin 
  • Trouble sleeping, lots of yawning 
  • Diarrhea or nausea (throwing up) 
  • Stuffy nose or sneezing

Planning Before Delivery

Because your baby will be at the hospital for further treatment after you are discharged, you may want to consider:  

  • How to Answer Questions: What will you tell family and friends when asked why the baby is staying in the hospital, especially if they are unaware of your medication or substance use? 
  • Travel: How are you going to get to and from the hospital to visit your baby?
  • Parking: How to pay for parking? (Garage parking is $2 each visit, but only if you get a discounted pass. Some free parking is available in the neighborhoods near the hospital, but pay attention to parking signs as some areas require a parking permit. 
  • Meals: When visiting your baby in the hospital, meals are not provided for you. Consider packing food or bringing money to buy food.
  • Childcare: Who will care for your other children when you visit?

What To Expect After Delivery

Your baby will be tested for opioids at birth. The nurses will check your baby for signs of withdrawal using a tool called the Finnegan NAS scale. Your baby will have the Finnegan score checked every few hours until he or she is ready to go home. If the baby’s Finnegan score is high, treatment will start to keep the baby comfortable during withdrawal. Medicines and other comfort care will be used in the hospital.

Your Baby's Hospital Stay

Your baby will be in the hospital for at least five to seven days after delivery. This is done so the care team can determine if your baby needs medicine to help with withdrawal. Your baby will be able to leave the hospital when there is little risk of serious problems or he or she is weaned off the medicine. Many babies who need medicines for withdrawal stay in the hospital for up to three or four weeks.

Unless you have problems during delivery, you will likely leave the hospital in one to two days after you give birth. You will need to plan for visiting your baby while he or she stays at the hospital.

 

Visiting Baby in the Hospital

  • Parents can visit their baby or call for updates anytime, day or night.
  • Two visitors are allowed per baby in the Extended Care Nursery (ECN) or Neonatal Intensive Care Unit (NICU).
  • Visitors must be 14 years of age or older.  
  • Sleeping and eating are not allowed in the ECN.  
  • Food, supplies and transportation are not provided to parents or visitors.      

How to Best Help Your Baby

You are the best treatment for your baby! You can help your baby most by:

  • Staying close to your baby
  • Continually holding and swaddling your baby
  • Making skin-to-skin contact with your baby 
  • Keeping things quiet and calm around your baby (few visitors, no noise, no bright lights) 
  • Breastfeeding (if only taking prescribed medications)

Share this Page