FLOYD COUNTY — Dr. Braidi Huecker spent a lot of time in hospitals growing up, because she had to. As a Type 1 diabetic, she says she didn’t have a choice back then.
Now a practicing physician, she spends her time in Baptist Health Floyd, because she wants to. Her childhood is one of the things that drew her to medicine. Her first pregnancy is what pulled her toward her specialty: obstetrics and gynecology.
“My [doctor] was there the whole time and helped me through that,” Huecker said. “I thought that was possibly the coolest job ever.”
Huecker earned her undergraduate degree at Thomas More College, completed her residency at University of Louisville Hospital and has worked in private practice in New Albany for the last seven years.
Helping other women through pregnancy really did turn out to be the “coolest job ever,” said Huecker, who delivers about 200 babies a year.
“Getting to help them through what could be the best day of their life is really important and to help them through such a difficult situation, it’s important. Whether it’s vaginal, C-section, a miscarriage. If they lose someone, that’s a huge deal. I think it’s important to have empathy and sympathy in that situation. Pregnancy, it can be complicated. We see things from diabetes to thrombosis – blood clots during pregnancy – those things are sometimes unavoidable,” the doctor said.
Some things that complicate pregnancy are avoidable, though, and make Huecker's job that much harder, both medically and emotionally.
DULLING THE PAIN
According to a recent study, 14.37 percent of babies born in Indiana have opiates in their system, around 3.5 percentage points higher than the national average.
Just over 19,000 umbilical cords were tested from 21 Hoosier hospitals as part of the Neonatal Abstinence Syndrome pilot program. The program tests for a variety of substances in umbilical cords and was created to track Neonatal Abstinence Syndrome, a condition whose symptoms include tremors, poor feeding and unstable temperature. Symptoms vary based on what the baby was exposed to while in the womb, according to Stanford Children's Health Hospital.
In the practice where Huecker works, OB-GYN Associates of Southern Indiana, the number of patients addicted is closer to the national average, but she still describes it as a “staggering amount.”
“Every third night that I’m on call – every three weeks – a patient comes in actively withdrawing in the hospital. They could be 11 weeks along, 33 weeks along. It’s hard to tell what’s going on with them or how to best care for their baby,” she said. “And that’s just me. There’s also my partners. It’s the same rate. Every third night. That’s a few nights a week.”
When an expectant woman arrives in the throes of addiction, it can blur the line between labor and withdrawal or overdose symptoms.
“One of those nights it is a [placental] abruption because they took something and they end up delivering,” she said. “Sometimes they take something for their pain and they don’t have the same labor symptoms. They take something, it makes their pain go away. They might be ready to push and they don’t know it. They might be complete [fully dilated] and barely moaning. The usual signs we are looking for are different because of what they took. They might go up and go to the bathroom and be ready to go. We get surprised sometimes.”
In extreme cases, medical personnel may find themselves trying to save the life of a mother who has overdosed as well as her unborn child.
Huecker has performed the procedure once, while a medical resident in Louisville.
“They call you to the E.R., they are trying to save this lady and she’s pregnant. She’s overdosed … you only have 5 minutes to get the baby out from the time CPR was started. When they overdose in the field there is nothing you can do to save the baby.”
A WHOLE NEW BALLGAME
It starts the way all patient-doctor relationships start: with a first appointment. But once there, opioid-addicted patients present much differently.
“Sometimes they will come in right away, when they suspect that they’re pregnant. It’s hard for some of them, I think, because they experience pain and nausea and vomiting at a different level and their perception of these pains — nausea and vomiting — are different than someone not on opioids. They may perceive their pain differently because they constantly have a painkiller in their system. It may be four hours since their last dose. Are they pregnant? They may not know. Their symptoms may be different. Their periods may be off,” Huecker said.
Other addicted mothers come in much later in pregnancy, because they either don’t know they are pregnant or feel embarrassed or judged, she said.
Once a pregnancy is confirmed, “it’s a whole new ballgame,” Huecker said. One patient becomes two and the fetus is at risk for a number of things, from exposure to diseases to Neonatal Abstinence Syndrome to premature delivery. Challenges can arise, such as lack of transportation or support, that make it hard for the expectant mother to get consistent care.
“This is a disease and these are people and they’re not in control. It’s something that controls them ...,” Huecker said. “Pregnant ladies are already so vulnerable. The changes and symptoms and pain, everything that’s involved in pregnancy, it’s difficult no matter what, then you put [addiction] into play. It’s so much worse.”
Going from room to room of patients who are overjoyed to be welcoming a baby to one with a patient who is at best, unsure, and at worst, incapable, of becoming a mother and navigating the family dynamics can wear on a doctor.
“It’s really hard,” Huecker said. “I do my best to care for the patient, to try to relate to her and care for her needs, to do my best to do what she needs and address that. Seeing the family when they come, seeing the broken families, the families that have been there when the patient overdosed before. They’ve already used up their emotions or their money support. It gets more difficult as the addiction never goes away. They’re having such a hard time understanding what’s going on. They get upset and I have to be the buffer in between [them]. It hurts.
“It’s hard to walk between ‘This is the best day, we are bringing a life into the world, this is supposed to be such a celebrated event’ and ‘They weren’t ready for it, they don’t feel like they can take a baby home to their home or situation.’ I have to constantly try to remind myself that these are people. This is somebody’s kid. This mom is somebody’s mom. It’s tough and when the grandmother comes in, and she’s watching her baby have a baby. It’s such a powerful thing and for these patients that need so much more, it wears on you.”
A SHOT AT SOBRIETY
In her practice, doctors connect their patients with many different resources. “It’s a team approach,” Huecker said.
Patients who are ready for sobriety can be referred to Southern Indiana Comprehensive Treatment Center or Dr. Jonathan Weeks, a practicing obstetrician in Louisville who specializes in detoxing pregnant women. There are also methadone clinics for mothers early enough in pregnancy and who are able to adhere to the strict guidelines. Under no circumstances are the patients referred to law enforcement, she said.
“We try as best we can to get them what they need. It is very difficult because it’s something that’s not an easy cure. It’s not like strep throat; we can't give them an antibiotic and it’ll get better in a few days. It’s a lifelong treatment, it requires lifelong care.”
It doesn’t happen often, but she’s had success stories.
“One in particular came off her medication on her own. It’s rare. She was in a stable relationship, had a history of pregnancy loss," Huecker said. "I took care of her throughout her pregnancy. She came in for visits, had a successful delivery. This was something we spoke about every visit. What was she going to do next, how were we going to keep her off [drugs]. She was very motivated. She had a good reason. She had previously lost her pregnancies and she believed it was from her addiction. We have people that, it’s when they want help and they have to believe that they can do it and they need some family support. It's always nice and they’ll get the support from us.”
Postpartum, when a mother is no longer under a doctor's care, can be a critical time in her recovery.
"It’s once they’re not pregnant anymore and I don’t see them anymore, that’s when they have to keep it up, they have to go to meetings. … We have to try to help them set things in place for them so they can continue their good hard work that they were working so hard for during pregnancy. So they can continue it. I don’t think there are enough programs that have that bridge in place for postpartum for people to continue that treatment.”