Neonatologist and Medical Director of the Neonatal Intensive Care Unit, CAMC Women and Children’s Hospital, is drastically improving the health outcomes of West Virginia moms and babies.
As we read in the news and see around us every day, West Virginia has serious health challenges—diabetes and obesity, smoking, and opioid addiction among them. Helping those who are suffering takes the hands-on, day-to-day work of thousands of dedicated health care practitioners across the state.
But improving the health of West Virginians as a whole requires systemic change. That’s why, this year, we’re honoring six West Virginia health care professionals. As leaders of the largest industry in the state, they are fundamentally changing the ways we think about, practice, and pay for health care. They are our 2023 Changemakers of Care.
Dr. Stefan Maxwell—a neonatologist and medical director of the Neonatal Intensive Care Unit at Charleston Area Medical Center Women and Children’s Hospital—has been working with Kanawha County babies and their mothers for over 30 years. His life’s direction began to shift, however, with the rise of the opioid epidemic.
“In 2006, we saw way more ICU babies withdrawing from opioids throughout the state,” Maxwell says. So many were born withdrawing that hospitals ran out of NICU beds, and many critical infants had to be transferred out of state.
In response, then-Governor Joe Manchin brought stakeholders together from all over the state to identify areas of need in maternal and child health, including substance use in pregnancy. Shortly thereafter, the West Virginia Perinatal Partnership was created, and Maxwell was appointed chair of its Substance Use in Pregnancy Committee. As the organization evolved, he says the team began to realize the enormity of the prescription drug problem.
“It was overwhelming. We needed to get a handle on the use and abuse of these drugs and the effects on our babies. And then, just as we were getting much more competent and had almost wiped out the prescription drug issues, things changed again. Now we had women using heroin, which evolved into poly-substance use with lots of other different drugs, like fentanyl.” Maxwell and his colleagues initially did an umbilical cord tissue study in 2009 to look at the prevalence of substance use in pregnancy. They found that one in five babies in West Virginia had been subjected to a drug.
The Perinatal Partnership allowed Maxwell and his colleagues to develop programs to identify women who were using drugs at their first prenatal visit and refer them to treatment. Over time, data indicated the team was indeed making a difference. At Greenbrier Valley Medical Center in 2012, for example, 20% of women initially tested positive for substances. That number dropped to as low as 3% by delivery, and these programs have since expanded statewide. “Now, we’re close to being in every birthing hospital or area that takes care of women and children,” he says.
Maxwell’s favorite program is Drug Free Moms and Babies. He presented the model to Congress in 2015 as an alternative to the standard treatment for mothers who are using drugs and infants who are born dependent. His team and others in the state used several measures to determine an infant’s need for pharmacology; babies treated thusly spent three to four weeks in the hospital—an estimated cost of around $60 million per year—with approximately 4,000 babies being treated annually for withdrawal. Now, he and his colleagues try to use the mother as the center of care to feed and nurture her baby. This can shorten the average hospital stay to just over a week in many cases.
In addition, the program gives mothers a chance to keep custody of their children. “We get moms into early intervention,” Maxwell says. “For instance, if they’re on heroin, they can be weaned off over time. If the mom is committed to being in the program and monitored during the pregnancy, they should keep their baby. If we can keep moms and babies together, we won’t have so many being placed in foster care. That’s a success story.”
Despite the good work West Virginia medical professionals are doing, Maxwell says the stigma of addiction can be difficult to overlook. “When this epidemic was starting back in the early 2000s, everybody was disgusted with people that were using these drugs. But then you quickly realize this is a disease, and people are afflicted with this chronic addiction similar to diabetes or hypertension. When you look at it like that, it’s easier to understand what happens with these folks. This is where I focus my attention. These are the people that need our help the most.”
Maxwell’s impact on West Virginia’s mothers and children has been profound. However, he credits his team members and colleagues with much of the success. “I had no idea what I was getting myself into,” he says. “It’s the great people around me that make these things happen. I can’t do it all, so it’s these amazingly wonderful, smart people that we have assembled who take care of these things. We’re very lucky to have that here in West Virginia.”