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The WISH Center

Jane Shyken speaking with patient

Jaye Shyken, M.D.
Associate Professor for Obstetrics, Gynecology and Women’s Health; Specialist, SLUCare Maternal Fetal Medicine; Medical Director, WISH Center at SSM St. Mary’s Hospital

All In.

When Jaye Shyken, M.D., does something, she’s all in. Soon after Dr. Shyken started running, she completed her first marathon for charity. Fast forward—she started competitive racewalking and has completed marathons in 34 states.

It’s a framework to help understand how she views addiction. “When I started to treat addiction, it became important to me to understand addiction. It’s one thing to be sensitive and nonjudgmental, but it’s quite a different activity to change the culture around you. If you look at addiction like a medical illness—just like any other medical illness, then we should all be treating it. And I think that’s what we’re trying to accomplish.”

Creating that community-wide, systemic change is just part of what Dr. Shyken and her team are doing through the creation of the WISH (Women and Infant Substance Help) Center at SSM Health St. Mary’s Hospital—which provides comprehensive, high-risk maternity care for women who are struggling with substance use disorders. The WISH Center opened within the High Risk Clinic at SSM Health St. Mary’s Hospital in October 2014, moved to its own site two years later—and provides holistic care for mothers with substance use disorders and their unborn children.

The WISH Center operates on the foundational principles of medication assisted treatment (MAT)—the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. Pregnant women with substance use disorders are prescribed buprenorphine or they receive methadone from a federally-licensed program. With few exceptions, naltrexone isn’t used during pregnancy, however, new moms might be transitioned to naltrexone following delivery. Medication is just the first step for these moms. Behavioral therapy is a key part of the WISH Center model—all patients receive individual and group therapy from a substance use counselor.

In addition, the WISH Center provides wraparound community support, and/or community referrals to non-profit partners for up to two years, which ensures that new moms and their babies get the care they need after delivery—including life skills, parenting skills and even diapers—to help new moms maintain their sobriety.

The WISH Center Team

The WISH Center is comprised of a robust and dedicated team, both within the Center and outside the walls of the hospital. In addition to Dr. Shyken, patients are seen by a team of specialists from SLUCare and SSM including nurse practitioners, nurses, social workers (two antepartum, one exclusively postpartum), a sonographer and behavioral health counselor. A pharmacist from the St. Louis College of Pharmacy comes to the Center with her students weekly to provide medication reconciliation and smoking cessation counseling. Dr. Shyken is training a maternal-fetal medicine fellow on his outpatient rotation, and plans to train an addiction medicine fellow—a key part of the Center for Substance Use Disorders and Pain Management at Saint Louis University.

The time after a baby is born is the riskiest time for potential relapse for women with substance use disorders. The knowledge of this fragile time has helped dictate the WISH Center’s priorities.

Jaye Shyken, M.D.

The Fourth Trimester

The time after a baby is born is the riskiest time for potential relapse for women with substance use disorders. The knowledge of this fragile time has helped dictate the WISH Center’s priorities. The team developed a wraparound two-year program that continues care for new moms after the baby is born—that looks far beyond healthcare needs and into the life of the mom and baby. By developing a network of collaborations, the WISH Center is able to coordinate residential treatment, help with transportation, coordination with insurance providers and more.

“In a normal, low-risk pregnancy, visits are spaced monthly initially and become more frequent as pregnancy progresses. In the case of addiction, visits are more frequent initially as women become stabilized on medication and engaged in the treatment of addiction. At the WISH Center, frequency of visits is dictated by both the pregnancy and the acuity and stability of their addiction. It’s really important that they don’t fall off the rails after they deliver. And interestingly enough, there is a correlation between women who miss their postpartum visit and the risk of mortality. With pregnancy, there’s already a stigma that’s related to addiction. And I tell people all the time that there aren’t many people who are going to congratulate you for not doing something they don’t understand why you ever started to begin with. But we will. Because we recognize how hard the work is,” said Dr. Shyken.

30,000-Foot View

Dr. Shyken has been treating a latticework of intersecting diseases that occur along with the drug epidemic that have implications for pregnancies in her 20-year career, including sexually transmitted diseases, hepatitis C and HIV.

She’s seen the availability of drugs dramatically change over her career, and her 30,000-foot view of drug use allowed her to see the opioid epidemic as it was unfolding. “I think there were those of us working in medicine who have been in it long enough that recognized the opioid epidemic before everybody else did. And I was concerned about prescribing practices, I was concerned about how medicine was going to pharmacologic care exclusively. A lot of that has to do with what’s paid for. There were a lot of market influences in this sort of thing. I think I saw this happening for a long time.”

As opioid abuse reached epidemic proportions, the number of babies born dependent on these drugs also has increased dramatically. Today, the struggles facing WISH Center patients are both broader and far more lethal. Dr. Shyken and her team are available to treat both chemical dependency and substance use disorders, including cannabis use disorder, benzodiazepine use disorder, opioid use disorder, alcohol use disorder­—among others. Behavioral addictions may include gambling, sex and video gaming—a newly-recognized addiction.

Empowering for Mom, Healthy for Baby

Most WISH Center patients become the primary care provider for their babies once the baby is born. And while a number of the WISH Center babies are born with a need to go through withdrawal, it turns out that the best treatment for a baby who has been exposed to opioids—is their mother—which is incredibly empowering.

“Much like what we’ve assumed works for an adult, medication replacement has been for a long time the model for newborns. But, if you are experiencing shaking, the thing to do at first is to console the baby. What we have treated with morphine for years, those symptoms can be treated by keeping mom and the baby together,” explained Dr. Shyken.

Fewer than 10% of well babies require any medication for withdrawal, and even fewer require a trip to the ICU. In addition to the practice of keeping mom and baby together, the American Academy of Breastfeeding Medicine encourages breastfeeding for new moms who are engaged in their own sobriety in some way.

The WISH Center team is teaching moms a wide range of parenting skills to ensure a smooth transition into parenthood. “We’re using non-pharmacologic interventions first, so we teach moms how to handle their babies to decrease excessive stimulation, and how to swaddle, which is really important in helping them not get over stimulated,” said Dr. Shyken.

Advocacy: In Support of Moms and Babies

Dr. Shyken and her team are fierce advocates for their patients outside of the delivery room as well—for long-term systemic change—in Jefferson City and on Capitol Hill. For pregnant women who need addiction medication after their baby is born, they are testifying to extend Medicaid. They also provide advocacy support to the Division of Family Services. She is the 2019 recipient of the Missouri Chapter of the National Council on Alcohol and Drug Abuse (NCADA) Pioneer Award in recognition of her career dedicated to pregnant women with substance use disorders.

Dr. Shyken and the WISH Center team view their role as a distinct privilege. They recognize they have a small but powerful window—pregnancy and childbirth is a fleeting, extraordinary moment over a lifetime, yet they are welcomed into the lives of so many women and babies—helping to foster healthy families for life.

They’re all in.

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