The rhythmic thump, thump, thump of a baby's heart filled the room in the Portico at St. John Catholic Church in Westminster. All eyes were turned to a projector, as a picture of an ultrasound and warning labels against drinking while pregnant took over the screen.
September is National Recovery Month, and in commemoration, the Carroll County Health Department hosted a conference Thursday to raise awareness about a program the county launched two years ago to universally screen for substance abuse in pregnant women. A slew of different counties and agencies - such as substance abuse prevention specialists, Department of Social Services, health departments and more - learned about the county's Screening, Assessment, Referral and Treatment initiative.
In Carroll County, about 50 percent of pregnant women continued to drink after they knew they were pregnant. This shocked members of SART, which launched in September 2010 to combat this very issue, said SART chairwoman Susan Doyle.
"What we're trying to educate people is that there is not any safe amount that has ever been determined to drink [while pregnant], so don't drink," Doyle said, who is also the director of the county health department's Bureau of Prevention, Wellness and Recovery. "It's the number one preventable cause of mental retardation. It's so much easier to prevent than to deal with the problems."
SART's inception
In 2005, Cindy Marucci-Bosley was concerned. As the chairwoman of the Fetal Infant Mortality Review Board at the time, she had several cases of deaths with inconclusive causes.
She was worried a mother or family member's substance abuse, which includes drugs, wine, beer, spirits and tobacco, could have been a factor.
So she placed a call to Doyle, then-director of the county health department's substance abuse services, who agreed it was time to craft an action plan.
"What motivated me more than anything is when a doctor said, 'I know when crap is coming out of a woman's mouth; I just don't know what to do with that crap,'" Doyle said.
In 2008, there were rumblings in the community that education and preventive measures on the issue were needed.
Drinking alcohol while pregnant can lead to fetal alcohol spectrum disorders, which can cause the child to have intellectual disabilities, heart problems and hyperactive activity, according to the U.S. Centers for Disease Control and Prevention. Using drugs can cause similar side effects. Marucci-Bosley, now SART co-chair, wanted to combat these preventable health problems.
The Carroll County Fetal Infant Mortality Review Board held a community forum with representatives from 17 different agencies and programs, such as obstetricians and health department officials, to develop a tactic.
SART was born after two years, multiple meetings and a conference held by doctors from the National Training Institute Upstream - a company that publishes resources for the healthy development of children and families.
Now, there's a procedure that's easy for doctors, medical technicians and nurses to follow if they learn a pregnant woman is using drugs or drinking alcohol, Doyle said.
"Change is scary," she said. "It changed all of us. It changed how we do things. It changed relationships."
The change was universal screening, meaning medical technicians and registered nurses ask all pregnant women a host of questions related to substance abuse, tobacco, depression and domestic violence at the patient's first prenatal visit. Beforehand, doctors only asked patients on Medicaid this set of questions, according to Doyle.
"There is absolutely no profiling, no matter who you are," Marucci-Bosley said at the conference, adding even the governor's wife would be screened.
The inquiries are called the Four P's - parents, partner, past and pregnancy - and follow-up questions are asked depending on the woman's answers, according to Doyle. Allegany is the only other county in Maryland that Doyle knows of that screens patients universally, she said.
At first, the questions were difficult to ask. They're personal, seemingly prying into a patient's life. But they're necessary for the unborn baby's health, Doyle said. And now, the process is smooth; rattling off such questions has become second nature.
If the screening shows up positive, the physician expresses concern to the patient. Then the results are forwarded to a SART specialist, who meets with the patient to determine if there should be another assessment or to give a referral for an appropriate treatment course, according to a PowerPoint handed out at the conference.
"The hospitals are reaching out and seeing public health is a partner," Doyle said.
Women may refuse treatment, against the advice of their physician and a SART nurse.
At least we could say, look, we tried our hardest to help ensure the baby's health isn't compromised with complications related to substance abuse, Doyle said.
The next step
SART's work is anything but complete.
Carroll County has the highest rate of women from September 2010 to September 2011 who continue to drink after learning they're pregnant. This statistic is of the health departments in at least six states that use the four P's plus follow-questions approach - although every county in that state might not use it.
And that's alarming, Doyle said.
"We got our data," Doyle said, "and sat there and looked at it, and we were confused."
Ira Chasnoff, a doctor with NTI Upstream who helped the county develop SART, said this could be attributed to the abundance of wineries in the area, according to Doyle.
So SART members will continue to educate women on the dangers associated with substance abuse during pregnancy. It will apply for grants to add extra money to the county-funded program.
But the group has also decided to craft a new action plan catered toward treating children who were affected by a substance in utero. In December, SART members will attend another NTI Upstream conference, gaining knowledge to create a treatment program.
"You see the kids in class who are jittery, who can't concentrate," Marucci-Bosley said at the conference. "You really wonder where it started."
So SART officials will start making a new treatment plan and continue to compile the data and try to stop substance abuse early in pregnancy, all of which is needed in the county, according to Imelda Udo, an obstetrician with Carroll Health Group OB/GYN and a SART team member.
"This is a very important thing we're doing here in Carroll County," she said at the conference. She said at the conference that she thought working in Carroll County was going to be a "cake walk" as far as this issue was concerned. Boy, was she wrong, she said.
