Missouri Confronts Maternal Mortality by Closing Addiction Care Gaps

For pregnant women with opioid use disorder, the safest path runs through medication-assisted treatment under medical supervision, not through withdrawal faced alone.

Missouri is rebuilding its maternal care around that principle after the state’s Pregnancy-Associated Mortality Review Board found that every substance use-related pregnancy death it examined was preventable.

The problem reaches well beyond those case files. Missouri saw nearly 1,500 drug-related deaths in 2024, according to the state Department of Mental Health, and rural residents face added hurdles to specialized care, hurdles that multiply for women navigating pregnancy and addiction at the same time.

Seven Preventable Deaths Forced a Rethink in Missouri

The review board found that seven of the 108 pregnancy-related deaths from 2019 to 2023 were attributed to substance use disorder, and all of those deaths were considered preventable. The board examines whether doctors or nurses missed chances to identify substance use or connect patients with treatment, said Dr. Kimberly Brandt, the board’s chair.

Some of the most troubling cases involved women already in care. Dr. Traci Johnson, a maternal-fetal medicine specialist at University Health in Kansas City and a board member, described deaths in which a patient’s substance use was not identified, or in which changes to medications set off a chain of events ending in overdose.

“We see things like people having opioid use disorder, they are in care, receiving care and have medications on board for opioid use disorder, and because of a lack of understanding in how to care for the population, clinicians will mess around with their medications, which sets off a constellation of events,” Johnson said. “And then it ends in overdose.”

Why Medication-Assisted Treatment Demands Expertise in Pregnancy

For opioid use disorder, medications such as methadone or buprenorphine are recommended during pregnancy. These medications stabilize the parent and protect the pregnancy, and stopping or adjusting them without a clinician who understands both addiction and obstetrics can trigger a crisis.

That is the clinical gap Missouri’s new programs are designed to close by bringing addiction, psychiatric, and pregnancy care together instead of expecting patients to coordinate them separately.

Programs That Put Every Kind of Care in One Place

Johnson helped design the EMBER program at University Health, short for Empowering Motherhood through Behavioral Health, Education and Recovery, which launched in August 2025.

The program brings doctors who work with mothers and new babies into an addiction and psychiatric treatment setting, with ultrasound services in the same building to cut down on travel.

Staff assess far more than substance use, asking about housing, food insecurity, transportation, intimate partner violence, and legal concerns. Johnson estimates about 80% of patients do not have consistent access to transportation. “Someone will literally come pick them up and bring them to their appointments,” she said.

Across the state in St. Louis, Brandt runs the BRAVE program, Building, Recovery, Advocacy, Validation and Empowerment, which uses telehealth to connect pregnant and postpartum women with addiction, psychiatric, and obstetric specialists. “We are able to potentially connect with patients in rural areas who wouldn’t otherwise maybe even have a psychiatrist in their county,” Brandt said.

Peer Specialists Who Have Been There

The Missouri Perinatal Quality Collaborative is testing another piece of the puzzle through Project STORK, a pilot that pairs pregnant and postpartum women with certified peer recovery specialists trained in maternal health. The pilot works with Chestnut Health Systems, Compass Health, and Centerstone.

“You connect with someone who’s been in your shoes,” said Alison Williams, who runs the collaborative. “You can build trust with them.” Her team will track whether having a peer increases treatment entry and supports sobriety. The findings could help determine whether Medicaid reimburses more peer services.

Missouri’s extension of Medicaid coverage through the first year postpartum gives providers a longer window. “We have about two years with this individual where we can reach in and try to make a difference,” Williams said.

The Barriers That Keep Women Silent

Fear remains the biggest obstacle. “I think the barrier is really trying to figure out who the women are,” said Lori Epley, who runs program outreach at Chestnut Health Systems in Hillsboro, Missouri. “Because I think they’re very scared and fearful to disclose that information to anyone, because there could be potential consequences with their children.”

Even logistics can undo good intentions. Shari Cook, a family nurse practitioner at Missouri Ozarks Community Health in Ava, Missouri, can now refer patients to substance use counselors in the same building where they get pregnancy care.

Even so, patients report Medicaid-covered rides that never arrived and appointments missed because they were not scheduled far enough ahead.

Finding Safe Treatment During Pregnancy in Missouri

If you are pregnant or postpartum and struggling with substance use, treatment that combines prenatal care, addiction medicine, and mental health support is available in Missouri, and asking about it at any prenatal appointment is a safe first step.

Programs like EMBER and BRAVE accept referrals, and peer specialists can help with transportation, paperwork, and the fear of reaching out. Search Detox.com’s directory to find detox centers in your area, or call 800-996-6135Sponsored to speak with a treatment specialist today.