After learning she was pregnant and then spending a weekend in jail, Autum knew it was time for a change.

As a condition of her release, the court referred her to the Center for Addiction and Pregnancy (CAP) at the Johns Hopkins Bayview Medical Center, an outpatient program that provides comprehensive and coordinated support for pregnant women with substance use disorders and their babies.

“They are very open-minded and easy to talk to,” says Autum, who preferred not to use her last name. “They kept me from relapsing and now they’re teaching me how to function as a mother with a newborn. We work on my self-esteem, and they’ve taught me how to care for myself.”

The program includes a broad spectrum of care to address a wide range of issues. Health care services include substance use treatment, psychiatry, obstetrics/gynecology, pediatrics and family planning. CAP also offers transportation, medications such as methadone or buprenorphine, and an overnight housing unit.

Autum, who joined the program in September 2019, says she visited the center every weekday before the COVID-19 pandemic, but getting free of substance use has taken time. While she stopped using cocaine in September, she had a difficult time not using marijuana.

“I didn’t have my first clean test until December,” says Autum. “I was arguing with my family and my fiancé. I felt like I couldn’t trust anybody and I didn’t feel like I had meaning.”

Autum is now participating in daily Zoom meetings and has regular appointments with her doctor and counselor. While Autum misses the routine of visiting the center every day, she says the Zoom meetings help her realize the struggles she faces are not hers alone.

“It’s the best feeling to know that I’m not all by myself,” she says. “Groups are like a security blanket. We give each other advice and encourage each other. Having to look people in the eye every day, it’s harder to lie and hide using. We’re all dealing with the stresses of being new moms or getting ready to be new moms and they’re giving us the tools to stay clean.”

Autum gave birth to a healthy boy in April. She says she’s thankful that her counselor regularly called to check in and that she still had the Zoom groups to attend.

“Life’s good,” she says. “We started saving money and my fiancé and I have gotten our own place. We’re able to buy things to take care of the baby in the right ways. We don’t argue as much and I’m thinking more clearly.”

Cassie Alleman, CAP’s manager of treatment services, says transformations like Autum’s are heartwarming.

“I love watching women turn into empowered, strong mothers,” she says. “The transformation over time when a woman finally gets to a place where she’s able to make healthy choices and speak positively about herself, it’s just incredible.”

The center was founded in 1991 and relies on referrals, Alleman says. Due to the pandemic, CAP is currently providing 15 therapy groups via Zoom. Patients can still come in to see their providers or they can have visits over the phone.

“Support is one of the most important things in recovery,” Alleman says. “I'm grateful that we are able to hold a safe space virtually so that the women can receive support from each other."

The center hosts three 60-minute group sessions every weekday, which cover topics such as boundaries, self-care, healing from loss, motherhood, recovery, relapse prevention and understanding pregnancy. Between eight to 12 women log in to each group.

“The women have an opportunity to share what’s going on with them related to the topic, talk about what they’re struggling with and tell us what kind of support they need,” Alleman says.

Nurse Nancy Spencer, who hosts several of the Zoom sessions, says teaching about labor and delivery is a little harder virtually, but she’s glad to have a way to support her patients.

“I love working with patients. I’ve gotten to know them better,” Spencer says. “It’s so rewarding to know that we’re helping them to stay focused and take their babies home when the time comes. The more involved they are with the center, the better they do.”

Mental health therapist Megan Mitchell says she has found that meeting virtually has been beneficial for the women who use the center because many have newborns at home and meeting virtually is more convenient for them.

“We communicate closely with them and help them with barriers to technology,” she says. “We ensure they’re in a confidential environment. We’ve also set up computers on-site so women can join each group here if they’re more comfortable.”

Mitchell says group therapy helps normalize what the women are experiencing in addiction.

“There’s so much shame and isolation that goes along with it,” Mitchell says. “The first step in the therapeutic journey is to realize what’s going on and talk about it openly and freely. It gives them a safe place to know they’re not alone.”

After women deliver their babies, CAP parenting coordinator Martha Velez helps them navigate motherhood. She says Zoom meetings are useful because she can see what is going on in the home.

“It’s a good thing for me to see the babies in their home environments,” she says. “I can assist during feedings or with establishing healthy sleeping habits, or changing the diapers. I watch how babies interact with toys and see how the moms interact with the babies.”

Velez also helps the moms to modify their behaviors to help the babies remain calm.

“I encourage them to respond to the baby’s cues of discomfort by changing their positions, holding their hands, using pacifiers when they burp,” she says. “Each baby is unique and we try to educate the mother that all babies respond differently to stimuli. We want them to be aware of the signs the babies give to modify the responses according to the baby’s needs. They get to know their babies and they can keep working on staying in recovery while becoming mindful mothers.”

Mitchell says she has much admiration for the women’s resilience.

“They work hard against the beast of addiction. I’m so impressed with their ability to thrive amid such difficult circumstances. I love seeing the women transform themselves and their lives for themselves and their children. Some come from such horrible trauma and devastating backgrounds. It’s truly incredible to see them turn such a positive corner and thrive in recovery.”