The number of women giving birth while on methadone at Magee Women's Hospital has been steadily increasing — as has the number of young, drug-dependent women in the region.
When a methadone-dependent woman at Magee is choosing her pre-natal care, she has two options. She can see one of the hospital's 183 ob-gyns, or one of the nine midwives. And even though there are fewer midwives, and methadone-dependent women are a smaller fraction of the population, the majority of them opt for the midwives — and in turn, many of the women the midwives see are methadone-dependent.
Even though the practice of midwifery predates recorded history, the midwives program at Magee wasn't started until the late 1990s.
Midwifery didn't always have the cachet that it has now. The midwives had to educate people about what they did. The number of certified professional midwives has risen from 54 to nearly 2,000 in the last fifteen years, according to the North American Registry of Midwives.
At the same time, the now defunct St. Francis Hospital in Lawrenceville was shuttering. It was hemorrhaging money despite serving an important role in the community. It reached out to a population that was most vulnerable, and addressed some of the public health problems that were most pervasive.
Michael Flaherty, who ran the psychiatry and addiction center at St. Francis, started a program that provided pre-natal care for drug-dependent women and delivered their babies.
It was successful, but not financially sustainable. When the hospital closed, many of the programs, including the one for the expectant mothers, weren't absorbed by other institutions.
"Since St. Francis closed, others — Western Psychiatric Institute and Clinic, most notably — tried to pick it up. But there isn't that pre-natal, obstretical focused area anymore. We don't have it going in the city," he said.
Many of those women now wind up at Magee, where Bawn Maguire is an outreach coordinator.
"We did not have any experience with patients with this diagnosis," she said.
Maguire set up a specialized program at the hospital that does methadone induction in pregnancy and funnels that population towards the midwives.