Childbirth treatment options lack for opioid-using women in rural areas

A recent University of Minnesota study found that opioid-affected births are increasing in rural areas.

Lew Blank

A study released by the University of Minnesota late last month found that opioid-using women in rural parts of the U.S. often lack adequate health treatment during childbirth.

The number of children in Minnesota with neonatal abstinence syndrome, a harmful disease seen in the children of opioid-using mothers, has increased by 70 percent between 2012 and 2016, according to the Minnesota Department of Health. A driving factor behind the increase is a lack of high-quality opioid treatment in rural clinics, according to the research.

The study discovered that rural women with opioid use disorder gave birth in rural hospitals 62.5 percent of the time, while a minority — 37.5 percent — migrate to urban hospitals for natal care.

This can cause problems for children with NAS, as rural clinics often lack the training, funding and resources of urban hospitals.

When opioid-using mothers in rural areas give birth, they often don’t have the time or the money to travel long distances to an urban hospital with high quality treatments for NAS, said Bert Chantarat, a University graduate student who helped analyze the results of the study.

“They may live in somewhere like Bemidji and they have to go to a hospital … miles away,” Chantarat said. “That’s a big issue.”

Rural clinics are less likely to be certified to provide medication-assisted treatment, a common treatment for opioid disorders. This can leave children born to opioid-using mothers at greater risk to the effects of NAS, the symptoms of which mimic the dependency and withdrawal experience of regular opioid users, said Holly Geyer, a doctor at the Mayo Clinic with expertise in opioid disorders.

“Out in rural areas, where you might have only a nurse practitioner or a physician assistant … our patients don’t get [medication-assisted treatment],” Geyer said. “Patients are unlikely in many circumstances to travel all the way back to urban areas just to receive a prescription.” 

It is especially difficult for rural women to seek care in urban clinics because prenatal care typically requires multiple hospital visits, which poses a financial barrier to rural women, said Cresta Jones, who studies opioid use and its effects and helped conduct the study. 

One solution to the disparity between the quality of care in urban and rural clinics is training to rural doctors how to properly treat NAS, said Kurt DeVine, a doctor who leads initiatives throughout Minnesota to expand opioid treatment to rural communities.

“It’s about education,” he said. “We go to a lot of places and … we almost always convince a fair number of the people there that [opioid treatment] is a very useful and convenient type of thing to have available all over rural areas.”

Jones said it is also important to allocate more funding and resources to rural doctors at both the state and federal level in order to provide better care for children affected by NAS.

“We can’t just be building … centers of excellence in the urban areas,” she said. “We need to get out to the rural communities, train providers there and give them the resources to give the same [opioid treatment] in rural communities as we would in more urban communities.”