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New program aims to help moms and newborns affected by drug use



For The Gazette  
Monday, June 25, 2018

Birth is mostly full of joy, but the weeks just before and after birth also can be stressful, especially for families dealing with opioid use disorder.

Some babies whose mothers have opioid use disorder will be born with a condition called neonatal abstinence syndrome, which means they are withdrawing from opioids (either prescribed or illicit.)

Babies with this syndrome are fussy and hard to soothe; they cry a lot and don’t sleep well. Sometimes babies remain in the hospital for several weeks after birth to receive treatment for withdrawal. Most heartbreaking is when the baby is placed in foster care.

With time and treatment, the symptoms of neonatal abstinence syndrome disappear. The rate of babies born with this syndrome has at least tripled since 1999 with national data showing six in 1,000 babies affected in 2013. Fortunately, neonatal abstinence syndrome is not common —  my colleagues and I at Cooley Dickinson Medical Group Women’s Health in Northampton typically see one or two babies each month with NAS.

Through special care, we believe we can better support mothers and babies affected by opioid use disorder, offering them a chance for a healthy life. Our pilot project, New Beginnings, aims to identify at-risk women as early in pregnancy as possible to develop a relationship with them built on trust and a shared goal of delivering a healthy baby.

Through group prenatal care and a postpartum support group, we encourage women to help each other. Peer support is one of the best ways women can stay strong to remain substance free during their pregnancy and postpartum period. We work closely with each woman to assess her situation and help the mother-to-be develop goals and a plan to reach them.

New Beginnings provides patients with education on important topics like newborn care, breastfeeding, postpartum care, stress management and expectations for their stay in the hospital. We also link patients to services and mental health treatment.

One of the new resources we offer is the “Parent Guide to Neonatal Abstinence Syndrome (NAS): Helping you care for your newborn,” which provides information on what to expect for the hospital stay, care and feeding of a newborn, the home environment and the importance of follow-up visits for both baby and mother.

Another goal of New Beginnings is to improve access to medication-assisted treatment (MAT), such as buprenorphine (commonly known as Suboxone) or methadone. MAT is highly effective when it is coupled with behavioral counseling and support and is the recommended treatment for opioid use disorder in pregnancy. This treatment is a safe option for pregnant women because it reduces the risk of withdrawal and relapse, both of which are extremely risky to both mother and baby.

Recently, Cooley Dickinson clinicians started using a new practice called Eat/Sleep/Console which is a method of evaluating withdrawal symptoms in babies.  It focuses on whether the baby is having difficulties with eating, sleeping or being comforted due to symptoms of withdrawal. Mom is taught to provide particularly soothing care to the baby, such as skin-to-skin contact, swaddling, rocking and breastfeeding. Medications are used to soothe withdrawal symptoms only when the other approaches aren’t sufficient.  This technique relies on teaching parents to help with assessing their baby by showing them how to record newborn eating, sleeping and fussiness in a diary.

This assessment happens in a room shared by mother and baby for 24 hours a day, in a practice called rooming in.

Recent research has shown that rooming in significantly improves results for babies with Neonatal Abstinence Syndrome. Pediatric hospitalist Dr. Helena McCracken notes that the Childbirth Center at Cooley Dickinson Hospital has practiced rooming in for many years, and that the Eat/Sleep/Console approach supports what is already in place in the Childbirth Center —  and goes further.

“This new tool helps us shift the conversation from a provider-led approach to one that puts the parents and their baby at the center of the care team,” McCracken said.

New Beginnings, one of several projects established through the Cooley Dickinson Opioid Task Force, is funded by Cooley Dickinson and the City of Northampton Health Department (through Hampshire HOPE’s federal Substance Abuse and Mental Health Services Administration grant.) Other initiatives of Cooley’s Opioid Task Force include staff education to reduce stigma, increasing the number of providers qualified to treat patients using MAT; and staff training to improve screening and referral to services.

While New Beginnings is in its infancy, we are encouraged by results so far: referrals for substance use treatment, collaboration with pediatricians and engagement by pregnant women in group prenatal care. We hope the initiative will have a lasting effect on the lives of children, mothers, families and the community.

The work I’ve been part of with New Beginnings brings to mind my early awakening years ago to what would become my calling. As a teenager, scared and in need of health care, I received patient and empathetic help from the kind hands of a nurse practitioner.  From that moment, I knew I wanted to do the same later on, supporting people in vulnerable times.  I became a nurse midwife and I am grateful that guiding families through pregnancy and birth is what I do every day.  Every mother and baby counts —  and deserves no less.

Amy Walker, CNM is a Nurse Midwife at the Cooley Dickinson Medical Group Women’s Health program. A member of the Hampshire HOPE opioid coalition, she is one of several individuals who contribute to a monthly column in this space about local efforts underway to address the opioid epidemic.