Drug Free Mom and Babies (DFMB)

Pregnancy is a unique time in a woman’s life. For women with substance use disorders, pregnancy may

be one of the only times some women gain access to health care coverage for their medical care. The

increased motivation for improved health that often comes with pregnancy coupled with access to health

care coverage makes the prenatal and postpartum periods ideal for addressing substance use.

Since the founding of the West Virginia Perinatal Partnership in 2006, addressing substance use,

including the use of tobacco, alcohol, prescription, and illicit drugs, has been a major focus of the

organization. The need for a collaborative and coordinated approach was apparent, but developing a

system of integrated and comprehensive care presented a significant challenge.

In 2012, the Partnership developed the Drug Free Moms and Babies (DFMB) Program with funding from

the West Virginia Department of Health and Human Resources and the Claude Worthington Benedum

Foundation. DFMB, initiated originally as a four-site pilot, was structured using an integrated approach

that combines the medical and nursing team, behavioral health providers, substance use treatment

providers, and community resources into a seamless partnership to provide the best care for mothers and

their babies. After five years, a qualitative and quantitative evaluation of the pilot demonstrated a

significant reduction in illicit substance use by the participants, as well as improved birth outcomes for

their children. Since this modest start and through federal and state funding, DFMB has expanded to 20

clinical sites in operation or development. Nearly 4,000 women have been served through the program.

DFMB works at the community-level by integrating medical and behavioral healthcare through a strong

care coordination model that incorporates wrap-around recovery support services and social services.

While all sites are built upon the central hub of care coordination, there is flexibility to provide services in

a way that meets local needs and demands and is responsive to available resources. All sites include the

following components within their service model:

Analysis of the program over the years show that DFMB reaches low-income, at-risk populations. A

“typical participant” is a white, 27-year-old woman who uses tobacco and one or more illicit substances.

She is single, has one or two other children, is unemployed with a high school diploma or GED, and

receives healthcare coverage through Medicaid. Her pregnancy is unplanned. She most likely is identified

as using illicit substances during an initial prenatal visit.

While most DFMB participants are polysubstance users, for those using only one substance, cannabis

and opioids are the most common.

The vast majority of women in the DFMB program give birth to a full-term infant (84%). For women

receiving MOUD, neonatal abstinence syndrome (NAS) is an expected and treatable outcome that is

discussed by program providers during the prenatal period so that mothers are prepared for an NAS

diagnosis and treatment for their babies. During 2020-2021, twenty-eight percent (28%) of the babies

born to women in the DFMB Program were diagnosed with NAS. DFMB sites work closely with the West

Virginia Department of Health and Human Resources’ Child Protective Service staff before and after birth

to ensure the safety and well-being of the babies. The vast majority (74%) of babies born to DFMB

participants are discharged to their mother’s care, providing the best chance for parent-child bonding. The

impact of the program is evidenced by the following statement a DFMB participant shared with her

coordinator, “You were one of the main reasons I got to keep my baby. You told me everything I needed

to do, and you were right.”

The Partnership consistently monitors and evaluates its impact and continually seeks to develop

resources to drive program expansion and enhancements. Current initiatives designed to advance the

work of the DFMB program include an emphasis on tobacco cessation, comprehensive contraceptive

services, program sustainability, advancement of Peer Recovery Support Specialists, building capacity to

support family-centered care, and addressing domestic violence, particularly related to participants

experiencing substance use coercion.

DFMB programs throughout West Virginia have effectively helped their patients to reduce substance use

during pregnancy leading to more babies being born substance free. This results in healthier babies,

intact families, and more resilient communities. As one provider noted, “The program has helped prepare

moms prior to delivery. It has helped us as nurses taking care of the babies. The moms know what to

expect when they come in to deliver which enables them to work with us to help their baby and

themselves through this difficult period.”

The benefits of the program are many: dollars saved by keeping newborns out of neonatal intensive care

units, stronger bonds between mothers and babies, decreased strain on the foster care system, less

emotional and physical damage, and the movement of mothers and babies from survival mode to thriving.

The DFMB program has been a lifeline for thousands of women, babies, and their families.