As an obstetrician-gynecologist, Dr. David Ryan has stood alongside families through some of their most vulnerable and life-changing moments. He has delivered hope, healing and new beginnings to countless mothers and families across eastern North Carolina. Over time, he began to see a heartbreaking pattern, one he could no longer ignore.

More and more, Dr. Ryan witnessed the struggle of pregnant patients battling addiction. He saw mothers often stigmatized, overlooked and lacking access to specialized care. He knew that if the system was not working for them, something needed to change. In pursuit of a solution, he completed an addiction medicine fellowship in 2021 at the University of North Carolina at Chapel Hill and returned home to Greenville, determined to transform care for these patients.

Now serving at ECU Health as both an OBGYN and addiction medicine provider, all while teaching future physicians as a clinical assistant professor at the Brody School of Medicine, Dr. Ryan is helping lead changes in perinatal care.

The need for change is staggering. For patients with substance use disorders who are pregnant or have recently given birth, pregnancy and the postpartum period can be critical. Without support, many are left navigating recovery alone, placing both mother and baby at risk.

“In North Carolina in 2018 and 2019, one out of every four pregnancy-related deaths was an overdose,” said Dr. Ryan. “Seventy-five percent of all the deaths occur in the postpartum period.”

Those sobering statistics spurred Dr. Ryan and ECU Health into action. Dr. Ryan recently helped establish the ECU Health IMPACT Clinic, transforming care for pregnant patients with substance use disorders in eastern North Carolina. IMPACT stands for Integrated Model of Perinatal Addiction Care and Treatment, and it represents a patient-centered approach that brings obstetric and addiction services together in one place.

This integrated model, Dr. Ryan says, is designed to eliminate the stigma and fragmentation that often prevent pregnant individuals from seeking help.

“Patients who are pregnant encounter stigma when they have substance use disorders,” said Dr. Ryan. “It can be extraordinarily challenging to get treatment anywhere, but particularly in certain addiction clinics. It can be really hard to walk in there when you’re pregnant.”

By embedding addiction services directly into ECU Health’s outpatient obstetrics clinic, the IMPACT Clinic offers a safe, welcoming environment where patients can receive evidence-based care without judgment.

“What we are seeking to do and what we are doing is offering both obstetric and addiction care in the same setting, in the same visit, at the same time,” said Dr. David Ryan.

The clinic’s holistic approach goes beyond medical treatment. Patients have access to lactation consultants who help navigate breastfeeding while on medication, social workers who assist with housing and transportation, and mental health providers who address co-occurring conditions like depression and anxiety.

“With addiction comes mental health, and with mental health needs oftentimes comes addiction,” says Dr. Ryan. “There’s a large amount of overlap, so not only are we able to address the addiction, but if there’s underlying mental health needs, we can address that too.”

One of the clinic’s most important innovations is its team-based care model. Rather than seeing multiple providers in disconnected settings, patients are supported by a coordinated team of addiction medicine specialists, OB-GYNs, and high-risk pregnancy experts.

“To the patient, it’s all happening at one place,” Dr. Ryan said. “They feel like everybody has been a part of their team.”

Patients with opioid use disorder are 24 times more likely to die from overdose in the year after delivery. Recognizing this vulnerability, the IMPACT Clinic continues care after childbirth, offering telehealth and in-person follow-ups to maintain addiction treatment and mental health support.

“Just because they’re no longer pregnant does not mean that their time with the IMPACT Clinic has to end,” said Dr. Ryan.
ECU Health’s support of the IMPACT Clinic fills a critical gap in the region. It is the first and only perinatal addiction program in eastern North Carolina, joining just five others across the state.

“There’s a huge need in our community,” Dr. Ryan said. “Our ultimate goal is just to improve the health and well-being of the patients of eastern North Carolina.”

At its heart, the IMPACT Clinic is about more than medicine, it is about trust, dignity and healing.

“We work with patients who are pregnant with substance use disorders to give them a place where they can be honest, where they don’t feel like they’re judged, where they can seek out whatever care, help, treatment that they think they want,” Dr. Ryan said. “And ultimately, we look forward to just being a part of people’s journey and improving people’s lives.”