WCBE

To Help Newborns Dependent On Opioids, Hospitals Rethink Mom's Role

Mar 26, 2016
Originally published on March 29, 2016 8:24 am

Carolyn Rossi has been a registered nurse for 27 years, and she's been fiercely protective of infants in her intensive care unit — babies born too soon, babies born with physical and cognitive abnormalities and, increasingly, babies born dependent on opioids.

As clinical manager of the nurseries at the Hospital of Central Connecticut, Rossi works in the neonatal intensive care unit. Like many hospitals across the country, the facility near Hartford has seen a dramatic rise in recent years in the number of babies born with neonatal abstinence syndrome. The National Institute of Drug Abuse reports that more than 21,000 infants born in the U.S. in 2012 (the most recent year for which data are available) experienced symptoms of opioid withdrawal. The hospital says each such baby in its care costs roughly $50,000 to treat.

These fragile and fitful newborns present new challenges for hospitals. Some research suggests the children do best when they can be held for hours at a time, preferably by their mothers, in quiet, private rooms, as they go through the process of being weaned off the drugs.

But delivering care that way requires changing the attitudes of many doctors and nurses about addiction.

Rossi, for example, says her initial training in the best ways to care for newborns in withdrawal was very different from what the research now suggests.

"You know, we looked at it like, 'They are drug addicts and the baby is born a drug addict and we're trying to protect the baby from the mother,' " Rossi says. "Like we were going to cure the baby, but not cure the mother and the family. So it was a lot about taking babies away from moms."

That turns out not to be a useful strategy if you're hoping to engage the help and support of a mother who already feels stigmatized by her drug habit, says Kate Sims, who directs women's and children's services at the hospital.

"She's feeling guilt herself," Sims says. "And then [she] comes in here and, unfortunately, as best as we are as providers and nurses, we're also judgmental. And so it's felt."

A lack of trust between mother and a nurse makes treating the baby even harder, Sims says.

So the hospital is now trying to make sure everyone in patient care sees the addicted mother first as a mom. In some cases that means getting care providers to understand that addiction isn't a moral failure, and that many people who are addicted come from a lifetime of trauma. Rossi says it's been hard for nurses who have been trained to be baby specialists to become mom specialists, too.

"It's a big culture change for me personally, and I know for the NICU nurses that are in here," she says. "You really do believe you're doing the right thing until something like this comes along."

The hospital's approach to caring for these infants is changing, in other ways, too. Dr. Annmarie Golioto, chief of pediatrics and the head of the hospital's nursery, says a bright, loud and bustling intensive care unit is a hard environment for a baby going through withdrawal. So she's gotten approval to use a few rooms just outside the intensive care unit as a quiet, monitored space for a baby and mother to stay for as long as the baby needs it.

"We've had to figure out: 'How can we use our rooms differently?' " says Golioto. "How can we use our space differently? And how we can partner with mom differently to have that relationship with her, to say, 'We expect you to stay here with your baby and take care of the baby after you've been discharged.' "

Golioto hopes the new setting will shorten recovery times for the children and decrease the amount of morphine a baby needs to ease withdrawal. She's also hopeful these moves will inspire some mothers to think differently about their newborns.

"The thinking was, 'My baby is being taken care of. There are nurses there. There are doctors there. I don't need to be here. They're getting everything they need,' " says Golioto. "We're trying to change the thinking — 'no, they're not getting everything they need if you're not here. Because they need you.' "

Rossi says she recognized the value in this new nursing approach the very first time she saw it in action. It was last December, she recalls. Rossi gave a mother a hospital room to stay in for more than a month while her baby went through withdrawal.

"She was just thrilled," Rossi says. Though the mother couldn't be at the hospital 24/7, "she was here as much as she could be," the nurse says, "and just knowing that she had the flexibility helped me understand that she is a mom. She is a great mom. She wants to be a better mom."

Nearly every aspect of the opioid epidemic worsened in 2014, according to the federal government's latest figures. And even though the Hospital of Central Connecticut's programs are just a few months old, health care workers there hope the changes they've made in their culture of care will, at the very least, give vulnerable moms and babies a better start.

This story is second in our four-part series Treating the Tiniest Opioid Patients, a collaboration produced by NPR's National & Science Desks, local member stations and Kaiser Health News.

Copyright 2016 Connecticut Public Radio. To see more, visit Connecticut Public Radio.

Transcript

DANIEL ZWERDLING, HOST:

We've been taking a look recently at the growing number of babies on drugs, starting in the womb. I'm talking here about opioid drugs like oxycodone, hydrocodone and morphine. The babies are dependent because their mothers are. And after they deliver, hospitals typically discharge the mothers and keep the newborns behind for treatment.

But a hospital in Connecticut is shaking up the system. They're keeping the mother around longer. They're giving her a private room to take care of her baby. And that's helping change attitudes there about addiction. Jeff Cohen brings us part two of our series from WNPR in Hartford.

JEFF COHEN, BYLINE: For 27 years, Carolyn Rossi has been fiercely protective of infants in her intensive care - babies born too soon, babies born with defects, babies born dependent on opioids. And for 27 years, that's meant working with their mothers, who nurses sometimes saw as a threat.

CAROLYN ROSSI: You know, we looked at it like they are drug addicts, and the baby is born a drug addict. And we're trying to protect the baby from their mother, basically. Like, we were going to cure the baby, but not cure the mother and the family. So it was a lot about taking babies away from moms.

COHEN: The number of babies born dependent on opioids is rising, more than 21,000 of them nationwide in 2012. Some of them wind up in intensive care units like this one at the Hospital of Central Connecticut. It's bright, it can be loud, and it can bustle.

Kate Sims is here, too. She directs the hospital's women and children services, and she says that increase means it's time for some big changes. The biggest change? Treating mom as a mom and not as an addict.

KATE SIMS: So she comes in with a stigma. She knows that she's 'cause feeling it - guilt herself. And then she comes in here and, unfortunately, as best as we are providers and nurses, we're also judgmental. And so it's felt.

COHEN: And Sims says that feeling, that lack of trust between a mother and a nurse can push the mom away, making treating the baby even harder.

So the hospital has started to train its staff to think differently. That means recognizing that addiction isn't a moral failure and that many addicts come from a lifetime of trauma. Rossi says it's been hard for nurses who are baby specialists to be mom specialists, too.

ROSSI: It's a huge culture change for me personally, and I know for the NICU nurses that are in here because you really do believe you're doing the right thing until something like this comes along.

COHEN: The hospital's approach to caring for these infants is changing in other ways, too. Dr. Annmarie Golioto is the chief of pediatrics. She says a bright, loud, bustling intensive care unit is a hard environment for a baby going through withdrawal, so she's gotten approval to use a few rooms just outside the intensive care unit - quiet, monitored spaces for the baby and the mother to stay for as long as the baby needs it.

ANNMARIE GOLIOTO: So we've had to figure out how we can use our rooms differently, how we can use our space differently and how we can partner with mom differently to have that relationship with her to say, you know, we expect you to stay here with your baby and take care of the baby after you've been discharged.

COHEN: Golioto hopes the new setting could shorten recovery times and decrease the amount of morphine a baby needs as it's weaned off the drugs completely. She's also hopeful these moves will inspire some mothers to think differently about their newborns.

GOLIOTO: The thinking was, my baby is being taken care of. There's nurses there, there's doctors there. I don't need to be here. They're getting everything they need. And what we're trying to change the thinking is no, they're not getting everything they need if you're not here because they need you.

COHEN: Nurse Rossi said she only needed to see the change in attitude and approach work once to see the culture shift pay off. It was back in December, and she gave a mother a room to stay in for more than a month while her baby went through withdrawal.

ROSSI: She was just thrilled. And she wasn't here 24/7. She couldn't be here 24/7. She was here as much as she could, and just knowing that she had that flexibility, for me, helped me understand that she is a mom. She's a great mom. She wants to be a better mom.

COHEN: Nearly every aspect of the opioid epidemic worsened in 2014. And even though this hospital's programs are just a few months old, it's hoping that this culture change will be at the very least give at-risk moms and babies a better start.

For NPR News, I'm Jeff Cohen in Hartford.

ZWERDLING: That story is part of a reporting partnership with NPR, WNPR in Hartford and Kaiser Health News. On tomorrow's Morning Edition, a Cleveland woman learns just how difficult it is to find help for addiction while pregnant, but she finally lands in the right place. Transcript provided by NPR, Copyright NPR.