Cuddlers soothe newborns withdrawing from opiates at Mercy Anderson

July 1, 2016

A cadre of volunteers at Mercy Health — Anderson Hospital are holding newborns withdrawing from opiates and other drugs to calm the babies, and help them settle themselves to eat, sleep and grow.

"The big positive is the TLC — the touch to these babies. It gives them security," said Carmen Bowling, nurse manager of the family birthing center and special care nursery at the East Cincinnati hospital, part of Cincinnati-based Mercy Health.

Since 2013, the hospital has had a formal program to provide volunteers to the nursery to calm agitated drug-exposed babies whose mothers have abused drugs. Volunteers must show they've received certain inoculations, and they undergo about an hour's training before being dispatched to the special care nursery to rock and cuddle the newborns in a darkened room.

"You stay as long as you're able," said Donna Mullins, a 73-year-old retiree who was the hospital's first cuddler. "But, I personally try to stay three or four hours. Some of these babies can only sleep in a person's arms, so I stay so they can get that sleep."

Immediate and lasting impacts
According to the MedlinePlus online medical encyclopedia, newborns whose pregnant mothers had taken drugs such as heroin, codeine, oxycodone, methadone or buprenorphine can experience neonatal abstinence syndrome after birth. These drugs pass through the placenta while the baby is in utero. After birth, such babies commonly experience withdrawal symptoms, with the severity dependent on the type and amount of drug the mother used, and the baby's gestational age at the time of exposure.

Bowling said neonatal abstinence syndrome can cause serious problems for babies — they "can be born too small, can have breathing issues and feeding problems" and can suffer seizures.

MedlinePlus says gestational exposure to illicit drugs can have long-term consequences for babies, sometimes causing birth defects, low birth weight, premature birth, small head circumference, and problems with development and behavior.

Weaning process
Bowling said Mercy Anderson, in line with all maternity hospitals in Cincinnati, screens the urine of all delivering mothers and, when there is a positive drug result, the hospital sends the umbilical cord for screening. Depending on the drug identified, babies with a positive screen are kept for observation for 72 to 96 hours in the hospital's special care nursery. Babies experiencing withdrawal symptoms are given small doses of prescribed medications — Mercy Anderson uses methadone or phenobarb, decreasing the dose until the babies no longer require medication. Some babies do not require medical treatment and are ready for discharge. Others may need different medications that Mercy Anderson can't provide, and those babies would be transferred to a facility with a higher acuity nursery.

Bowling said the babies usually are treated in the special care nursery at Mercy Anderson about 14 to 17 days.

The symptoms of neonatal abstinence syndrome include significantly excessive crying, excessive sucking, hyperactive reflexes, irritability, rapid breathing, sleep problems, sweating, fever, trembling and other behavior and health issues.

Many of the babies cannot self-calm enough to take a bottle, so the volunteers soothe them. Mullins said of the babies' agitation, "Mostly, they are just irritable. Sometimes you know they're in pain. "

Mullins said in general, once she holds a baby firmly and gives a pacifier, the baby can usually settle in about five to 10 minutes, but it can take an hour to lull an agitated baby into a deep sleep.

Opiate epidemic
Bowling said there has been an increasing number of babies with neonatal abstinence syndrome at the hospital. She estimates that in 2015, the hospital's nursery treated about 40 babies with the syndrome.

A study reported in the May 28, 2015, New England Journal of Medicine found that the frequency of neonatal intensive care unit admissions for infants with neonatal abstinence syndrome across the U.S. had increased from seven cases per 1,000 admissions in 2004 to 27 per 1,000 admissions in 2013 in the cohort of infants studied.

Bowling said Mercy Anderson has counselors who try to intervene with substance abusing mothers before they give birth to help their babies have the best possible outcomes. The mothers are flagged by their obstetricians, and counselors work to direct the women to drug treatment programs, connect them with resources and prepare them for what to expect when their baby is born.

Once the mother has given birth, Bowling said, the hospital's goal is to keep her and her baby together. "The goal is safety, not separation. We try to educate her about being the best mother she can to her baby and work to help her make better decisions," such as the completing treatment if she didn't already do that before her baby was born.

Bowling said new mothers who are actively seeking drugs usually do not stay in the hospital long after giving birth and usually are not present during their babies' stays. When mothers are absent, Mercy Anderson staff try to locate and stay in touch with them during the baby's time in the hospital. Often the hospital's case management staff must get involved, to work with child protective services to determine the best destination for a child of an addicted and absent mother.

Bowling said the hospital cannot force treatment on a mother. "Our goal is to help the mother get healthy and keep them involved with the baby after the birth."


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