Building The Plane As We Fly It: Pregnant Women, Opiate Addiction, and Baby Cuddling

Everyone who works in addiction has heard the phrase “building the plane as we fly it” at least once. Aviation metaphors are common in the field. Nothing else quite captures the panic that many public health organizations feel as they try and address the crash-and-burn of opiate-affected communities. I see it firsthand as a Case Manager at River Region Human Services in Jacksonville, where I primarily serve clients who are in recovery from heroin or prescription drug abuse.

I also work closely with the one population that provokes more panic and urgency than any other: pregnant women with substance abuse disorders. Since babies born to these mothers were exposed to opiates in the womb, they often experience withdrawal symptoms after birth (medically referred to as NAS or Neonatal abstinence syndrome). Watching an infant suffer from opiate withdrawals is enough to inspire anyone to build a plane from scratch.

For my part, I provide case management services to pregnant and postpartum women, and I also design and teach “Building Blocks” classes to assist them in their recovery and parenting. Many of the Building Blocks participants have confided in me about what is really hurting their recovery. And this leads me to one of the hardest lessons I’ve learned since starting at River Region: some people firmly believe that a woman with a history of substance abuse is a bad mother. It’s not just the general public who has given up on these women - doctors and nurses too. I’ve heard multiple horror stories from my clients about the medical care they receive during pregnancy, ranging from a snarky comments from nurses to outright refusals to take them as patients. I thought maybe this was par for the course in Jacksonville because, when I tried to link my clients to certain social services, I would always get slow response times and claims of no availability. But when I stopped introducing myself as a Case Manager from a substance abuse clinic and started posing as a concerned friend or relative, these problems vanished instantly. 

Babies eat what mothers eat, including the stress about their pregnancies. I’ve made it my mission to reduce this stress by fighting for my clients. I want them to feel like they are in control of their health no matter what anyone thinks. On the flip side, I want healthcare providers to understand the scope of the opiate addiction and my clients’ needs, which will allow them to treat them without judgement.

The trouble is that we are, truly, “building the plane as we fly it.” I can see my objective - a smooth, easy journey through recovery, but I know I don’t have all the parts yet. I can’t Google a solution like I usually do because there is an incredible amount of vitriol and misinformation out there. Furthermore, few people have the access to or experience with this population. The ones who do are frantically building their own planes with little time to share their plans with me or even a successful plan to share. That means it’s been largely up to me, and the rest of the crew at River Region, to figure out how to navigate the needs of our expectant and new mothers.

To accomplish my goal of empowering my pregnant clients, I first turned to with the organization where the vast majority of my clients receive pre/post natal care and also deliver their babies: UF Health Jacksonville. I started by dropping in on the two National Health Corps members who serve there, Ian Fitzpatrick and Rebecca Ratusnik, and they gave me an excellent behind-the-scenes tour and thorough overview of their services.

I then followed up my visit by bringing in the Director of the Little Miracles Program in to speak at my Building Blocks class, and she came armed with a very large folder of healthy pregnancy information and services as well as a very genuine sense of caring. Though my clients dozed off during the third flyer on breastfeeding, I also saw one of them carrying around her folder over a month later and have overheard a few mothers’ (correct) assertions that it is easy to breastfeed at UF Health.

Last month I also coordinated with River Region’s Patient Navigator Roshini Pudhucode to bring eight of our inpatient clients to the Community Baby Shower at UF Health. They were happy to see us serving at the event and even happier to win prizes in the raffle. Nothing improves opinions like a free carseat or a six-foot-tall stuffed bunny. 

Finally, most recently, I started volunteering at the UF Health Jacksonville NICU outside of my service hours. My official position title, believe it or not, is “Infant Cuddler.” The NICU is a mandatory stopover for infants in opiate withdrawal, including my clients’ children. My goal here is to gain a better understanding of how UF Health operates and bring information back to my clients. I am also open with the nurses and doctors about my experience at River Region. I have already had the opportunity to explain the difference between methadone and methamphetamines and gotten a phone number from a nurse who wanted to talk further.

Ultimately, these are little fixes but put enough of them together and the journey starts to feel smoother. And more and more people are getting on board to help. I was recently at a conference where I heard a politician recite all the fatal plane crashes in Georgia’s history and their total death toll: 102. He acknowledged this as tragic, and then went on to point out that 91 Americans die everyday from opiate overdoses. If those were plane crash deaths, we would have solved this crisis within days. Truly - it’s time to get to work. 


This blog post was written by NHC FL member, Alicia Nelson.

Alicia serves at RRHS as a Case Manager.