Crisis in the maternity ward

Edd Cote Volunteers at local hospitals like UMass Memorial Medical Center in Worcester provide close contact for newborns addicted to opiates when parents aren't available. UMass Memorial volunteer Betty Maciulewicz is shown here.

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By Livia Gershon Special To The Worcester Business Journal

By now, everyone in Central Massachusetts probably knows something about the crisis in opioid abuse that’s hit the area and beyond in recent years. Directly or indirectly, the sharp rise in use of prescription painkillers and related street drugs like heroin has affected enormous numbers of people of all ages. And, sadly, that doesn’t exclude the very youngest. Hospitals, doctors, and recovery programs around the region are now implementing programs to address an alarming increase in the number of infants born with opioid addiction.A recent report from the Centers for Disease Control and Prevention (CDC) found that cases of neonatal abstinence syndrome (NAS) in Massachusetts rose from 2.2 per 1,000 births in 1999 to 12.5 in 2012. That’s even higher than nationwide increases of over 300 percent over a similar timeframe.

Local babies face higher risk

At UMass Memorial Medical Center in Worcester, a birthing hospital equipped to handle risky childbirth situations that other area medical centers can’t, the problem has been particularly visible. Dr. Lawrence M. Rhein, the hospital’s chief of neonatology, said nearly 18 out of 1,000 babies born at the hospital in 2014 were diagnosed with NAS, five times the national rate.

In some cases, babies are born with NAS because their mothers use prescription opioids for pain, or are addicted to the drugs. If a woman with an opioid addiction becomes pregnant, the CDC recommends that she use a methadone maintenance program rather than trying to quit cold turkey. Use of methadone can still result in an infant with NAS, but Rhein said the controlled level of the drug in the system of a woman using methadone under supervision is much safer than the quick changes in drug levels that an active addict encounters.

Infants born with the syndrome may experience gastrointestinal distress, often have a distinctive high-pitched cry, and can be hard to comfort. Rhein said doctors don’t know yet whether there are significant long-term dangers associated with NAS, particularly since it’s hard to separate the effects of the syndrome from other obstacles that face some children born to parents with drug addiction.

“What we do know is a baby in the first days of life is learning to feed properly, to interact with parents,” he said. “If instead you’re uncomfortable, jittery, feeding is not optimal. At least in the short-term, it has consequences.”

In an effort to address the rise in NAS, UMass has been working with other hospitals around Massachusetts through a $3.5 million state grant, $249,992 of which went to the Worcester hospital.

At UMass, he said, the team is building on work done by his colleague, Dr. Katherine Callaghan, who developed a prenatal care program for mothers in addiction recovery. UMass has created groups to let mothers with opioid addiction learn from each other and from peer mentors who have already been through the same struggles. Because breastfeeding seems to improve outcomes for babies with NAS, Rhein said, the hospital drew from a peer mentorship program in Chicago that’s successfully increased rates of breastfeeding.

Rhein said another factor in the health of babies born with addiction is close contact with their parents. If the infants need to stay in the NICU for an extended period, UMass now helps them with vouchers for transportation and meals so they can spend more time holding their babies. The hospital also uses a pool of volunteer “cuddlers” who hold babies when parents aren’t available.

Reaching out to mothers

Another Central Massachusetts hospital leading the way in addressing NAS is Milford Regional Medical Center. The Vermont Oxford network, a nonprofit focusing on neonatal care, named Milford a 2016 Center of Excellence for its work with opioid-addicted babies and their families.

Rose Galimi-Hayes, nurse manager of Milford’s maternity center, said one of the hospital’s top priorities has been providing support to mothers dealing with addiction.

She said the hospital began inviting the mothers in to talk before their due dates to explain NAS to them and let them know they’d get support in addiction recovery.

In some respects, public concern about NAS echoes worries about babies born in the 1980s and ‘90s to mothers who used crack cocaine. Concerns about those children’s long-term health turned out to be largely unfounded, and many observers now say families in the middle of the crack epidemic were unfairly stigmatized.

Galimi-Hayes said she and other health care workers are trying not to repeat those mistakes, and striving to respond to opioid-using mothers with compassion.

“A lot of nurses—they’re women, they’re mothers,” she said. “They become very protective of these babies, thinking, ‘how can these mothers do this?’ I needed them to see that these moms have problem, they have an illness, and we are responsible to the mother as much as we are to the baby.”

Galimi-Hayes said that, both for the nurses on her unit and for the public at large, the current opioid addiction crisis is often easier to understand than other drug epidemics because it’s affected large swaths of people from all economic backgrounds.

‘Desperate for treatment’

Still, expectant mothers in need of treatment may have trouble accessing it.

Fabiola Powell, clinical coordinator for pregnant and postpartum women at Serenity House, a Hopkinton-based recovery program for women that works closely with Milford Regional, said pregnant women and new mothers with opioid addictions often have multiple problems they need to address at once. Many face mental health disorders and physical ailments. Often, Powell said, they also need help learning work and parenting skills, as well as tools to cope with the heavy emotional load of new parenting.

“They’re really learning how to manage their own feelings, which is often masked and repressed by the substance abuse,” she said. Powell said she’s glad to see state officials, hospitals, and other institutions taking action to address the opioid crisis. But, for the moment, she said, not everyone can get the intensive help they need.

“The calls that we receive on a daily basis clearly outnumber the number of slots we have available in the program, she said.”

Meanwhile, Galimi-Hayes said Milford Regional has been working to keep mothers and babies together as much as possible in the hospital. Babies diagnosed with NAS must typically stay at Milford for at least five days, and up to a month and a half if they require treatment with oral morphine to address their symptoms. During that time, the hospital works to support their mothers in learning about their babies’ sensitivities and unique needs. And like UMass Memorial, Milford Regional has a group of volunteers, called the “snuggle squad,” who hold and rock infants when parents can’t be there.

Galimi-Hayes and the nurses who work for her are focused on the new mothers’ needs as well. In some cases, the mothers need to enter or continue a recovery program like the one at Serenity House.

“Our goal is to work really hard so (they) can be successful in her recovery and rehabilitation,” Galimi-Hayes said.