Caring for the smallest victims of the opioid epidemic

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The opioid abuse crisis that’s afflicting our nation has been front and center in the news for several years now. At least one, and usually more stories every day tell of its devastation on lives, families and livelihoods.

As a nurse in obstetrics, I see first-hand the impact of the opioid crisis that no news coverage can really do justice to – addicted babies born to addicted mothers.  After delivery, these newborns’ dependence on the substance will continue. However, since the drug is no longer available, the newborn’s central nervous system becomes overstimulated causing the newborn to exhibit symptoms of withdrawal.

To see these smallest victims of substance abuse born in a state of drug withdrawal brings home the gravity of the opioid crisis like nothing else can. And it is a crisis that does not discriminate. Many addicted patients started out with a legal prescription from their provider as a result of an injury or medical procedure. Some may also be on a medication-assisted treatment regimen and prescribed methadone or buprenorphine and naloxone. Unfortunately, these medications still result in neonatal withdrawal symptoms.

According to the Centers for Disease Control and Prevention, national opioid use disorder rates at delivery more than quadrupled during 1999–2014. Further, according to the National Institutes of Health, as many as one newborn is born every 15 minutes suffering from opioid withdrawal. Within my own hospital in Northeast Alabama, we typically deliver around 1700 babies per year. On a given day, we will have at least one newborn– sometimes as many as five – in the nursery, who are being treated for Neonatal Abstinence Syndrome (NAS). However, several more newborns are being scored/assessed every 3 hours for NAS each day.

These newborns experience withdrawals which slightly differ from the adolescent or adult. They experience tremors, insomnia, irritability and constant crying, potential seizures, poor feeding, excessive suck, diarrhea and vomiting, among other symptoms. The difference is, they are often only 24 hours old. These symptoms can occur between 24 and 72 hours after birth. It is all dependent on the type of illegal drug or prescribed medication and if there is polysubstance use, which will then only culminate into more severe symptoms of withdrawal.

These babies require a more intensive level of one-on-one nursing, including the specialized care to administer the morphine or methadone orally to decrease their withdrawals symptoms, then gradually wean them off of the medication. And because their discomfort is such that they can’t really be in a bassinet and treated like other newborns, we rely heavily on generous and compassionate volunteers to cuddle and hold them. We also provide non-pharmacological interventions such as dimming the lights and reducing environmental stimuli. We have a designated NAS nursery.

Needless to say, providing care for these little ones can be mentally, physically and emotionally exhausting for nurses, and something for which nursing school doesn’t always prepare you.  But the fact is, we are often the first and main point of care for both the babies and their moms, and our profession affords us an opportunity to make a significant impact in their lives.

According to the Center for Medicare and Medicaid Services, substance use is now a leading cause of maternal death. Statistics will tell us that there are numerous barriers to care for these women such as education, financial, lack of treatment programs and many others. From my view as a practicing nurse and educator, there are two barriers I see most frequently in practice – lack of ongoing education around substance use disorder (SUD) and the stigma.

Since 2015, nursing school curriculums have included education on SUD, how to recognize it, current treatments and other important information. These are critical components, however nurses who graduated before that time most often learned about substance use disorder on the job. Continuing education is a good option, but not always readily available. Many of our hospitals face staffing shortages that don’t allow us to take nurses away from patient care for training that’s not mission critical.  To truly understand and impact substance use, especially among pregnant women, we need to find efficient and effective ways to help our nurses and nurse managers learn how to identify the signs of substance use disorder and steps to intervene for the newborn and mom.

Secondly, it’s not hard to feel compassion for a baby born addicted, but for many nurses and providers, that compassion doesn’t extend to the mom. We can be taught to recognize the signs of drug addiction, but how do we learn to be empathetic? Any nurse can tell you that patients know exactly how you feel about them the moment you walk in the room. It’s evident from your non-verbal cues, the way you speak to them, and the amount of time you spend in the room. And that impacts their perception immediately. If a mom feels you’re judging her, she will not always be honest, and you won’t get the information you need to care for her or the baby. On top of that, we may be asked to keep the baby’s drug screenings or treatments from the partner or grandparents out of a mom’s fear that they will not understand and her not wanting relationship problems within the family unit.  Caring for these moms requires a different mindset, one that we don’t all naturally have. But at the end of the day, our purpose is to provide the best care possible for moms and babies.

There is no easy answer to this crisis, particularly when it comes to pregnant women and newborns, but preparing our nurses for the challenges – the emotional as well as the professional – is a step in the right direction.

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