September is NICU Awareness Month designed to honor families experiencing a stay in the NICU and to honor the health professionals who care for the them.
Ada Malone, RN, BSN, ANLC, IBCLC, a nurse working with critical care babies in Carbondale, Ill. holds a special place for neonates diagnosed with Neonatal Abstinence Syndrome (NAS). NAS is characterized by a group of conditions caused when babies withdraw from certain drugs– most often opioids– they’ve been exposed to in the womb.
From 1999 to 2014, the number of pregnant women addicted to opioids more than quadrupled, according to the CDC.
The opioid epidemic has called for all health care providers to take an active role in helping identify, treat and support the families the diagnosis affects.
“More and more health care systems are starting to really pay attention to the need to integrate services and help these families,” Malone reports. “Conversations are happening.”
Most hospitals in the U.S. use the Finnegan Neonatal Abstinence Scoring System (FNASS) to guide treatment of babies born with NAS. In conjunction with this method, Malone and colleagues have had success integrating non-pharmacological methods into mother baby care to lessen the severity of NAS symptoms. A literature review found that “given the increasing body of evidence on its efficacy and ease of implementation, non-pharmacological treatment should universally be incorporated into standard of care for NAS.”
Malone often hears concerns from health care providers and patients about the safety of breastfeeding babies born with NAS. She makes clear that mothers who are involved in a treatment program are encouraged to breastfeed their babies; opioid-maintenance therapies are not deemed contraindications to breastfeeding (Wong, Ordean, & Kahan, 2011). [Retrieved from: https://womenshealthtoday.blog/2017/08/22/opioid-use-and-breastfeeding/]
In fact, “breastfeeding serves as an appropriate treatment for managing infant withdrawal and has been associated with a decreased need for treatment of NAS (Welle-Strand et al., 2013).” [Retrieved from: https://womenshealthtoday.blog/2017/08/22/opioid-use-and-breastfeeding/]
Malone’s hospital has an overall breastfeeding initiation rate of 94 percent, but the data for mothers breastfeeding a baby with NAS has not been isolated.
One study found that 24 percent of mothers addicted to opioids breastfed to some extent during their infant’s hospitalization, but 60 percent of those who initiated stopped breastfeeding after just under 6 days.
Malone says that when appropriate, skin-to-skin contact can be the earliest intervention.
“When you are able to integrate non-medical interventions, such as swaddling, rooming-in and breastfeeding, these neonates tend have a shorter hospital stay,” she says.
Malone works to educate and engage parents through the process of caring for their babies. At her institution, if a mother is actively participating in the care of her infant, hospital staff make every effort possible to accommodate parents to stay in the hospital with their babies while they recover in the NICU.
Malone says that often, the stigma associated with addiction and NAS may pose a barrier to proper care for these mothers and babies. Negative and judgmental attitudes from health care providers can influence parents’ level of participation in their babies’ care.
“There are stigmas that really shut moms out,” Malone says. “Health care providers and other hospital staff who work with these families need to be aware of passing judgement and provide positive feedback and education to really try to ensure positive outcomes.”
She goes on: “When moms recognize that they are the primary person to assist their babies with recovery, coupled with a strong support system, they feel more engaged.”
Specifically, Malone says lactation care providers (LCP) can share evidence-based knowledge about infant feeding, facilitate breastfeeding plans between families and other care providers, and advocate for the mother baby couplet.
A collaborative approach, where support extends into the community, has proven to be the most effective way to serve families affected by NAS.
In Illinois, by partnering with stakeholders state-wide, the Illinois Perinatal Quality Collaborative has been instrumental in implementing programs across disciplines to better reach and support families. State and local programs such as Shawnee Healthy Families, a program designed to assist first time parents with parenting skills and education, provide strong support systems.
And Healthy Southern Illinois Delta Network helps reach families in rural areas where proper care might be more difficult to reach. The network helps connect programs and services to expand care.
For more information, Women’s Health Today has an easy-to-read blog post about opioid use and breastfeeding.