New mothers with opioid addiction challenge rural hospitals, University of Minnesota study finds

A substantial number of mothers with opioid addictions are giving birth in rural hospitals that are presumably less equipped to address their challenges and to manage the withdrawal symptoms that their babies suffer in their first days.

The University of Minnesota's Katy Kozhimannil examined births involving rural mothers with opioid-use disorders in the U.S. from 2007 through 2014 and found that 60 percent occurred in local, smaller-town hospitals.

"These rural hospitals may have more limited capacity to care for them and their babies," said Katy Kozhimannil, who directs the university's Rural Health Research Center.

Preterm birth, for example, is a complication that is best managed in hospitals with neonatal intensive care services such as incubators that support their continued growth when they are underweight. And yet half of the preterm births to mothers with an opioid addiction occurred in rural hospitals, according to Kozhimannil's research, which was published in the Journal of Rural Health.

Babies born to opioid-addicted mothers frequently suffer neonatal abstinence syndrome, or the withdrawal symptoms that occur when they no longer receive opioids that had been part of their feedings via the placenta. Symptoms include seizures, fussiness, sweats and difficulties eating and sleeping.

Kozhimannil said her study is based on the presumption that large, urban teaching hospitals are better equipped to handle opioid addiction during childbirth, and withdrawal symptoms in newborns.

Some rural hospitals might be capable of handling those challenges. Sanford Bemidji Medical Center, for example, used grant funding to launch a First Steps program that works with opioid-addicted mothers to get them in treatment before birth, and provides support services after birth.

The research findings simply point out that rural hospitals are facing this dilemma as much as urban ones and are in equal need of financial resources to combat it, Kozhimannil said.

The U.S. Centers for Medicare and Medicaid Services just recently launched a new funding initiative to pay for the coordination of substance abuse and prenatal care for low-income pregnant women. Kozhimannil said some of this funding needs to be earmarked to support specialists in chemical dependency and prenatal care who work in rural communities.