Opioid use has quadrupled over the last decade.1 As opioid addiction increases, so do the number of neonatal abstinence syndrome (NAS) babies that are admitted and cared for in the neonatal intensive care unit (NICU). By 2014, every 15 minutes a baby was born suffering from opioid addiction and NAS.2 As this epidemic continues to rise, the goal of the NICU is to keep parents suffering from addiction actively involved in the care of the baby. The ideal situation would include treatment for both parents, rooming in when possible, and parental involvement. Healthcare professionals often have negative attitudes toward these mothers who suffer from addiction and perceive them as stressful and difficult.3 Hospital staff should be educated on many aspects of addiction, including sensitivity and proper language when caring for parents of NAS babies.
Likewise, many NAS mothers have reported feelings of negative judgments by the nurses caring for their infant. However, the majority of NAS mothers experience guilt and remorse when watching their infant withdraw and worry about the long-term impact.4 In addition, the mothers did not feel the nurses properly understood the disease of addiction and circumstances in their lives that may have led to their choices.5
At our institution we were noticing an education gap based on responses and interactions between nurses and mothers with known substance use disorder. A program was developed using a forum style training specifically focusing on addiction as a mental health disorder. An obstetrician who specializes in antepartum and postpartum care and treatment for mothers suffering from substance use disorder presented information on the pathophysiology involved with addiction. Once a person is addicted to a substance, such as opiates, they need to continue to use the substance just to feel "normal" and it is no longer about achieving the high experienced initially. In addition, a drug addiction counselor, also in recovery, spoke about the importance of community advocacy and harm reduction. Most importantly, the NICU leaders felt the staff needed to hear the human side of this by bringing in mothers in active recovery whose infants were cared for in our NICU but who were pregnant during active addiction to share their stories and pathways to recovery. The mothers explained that how they were treated in the healthcare system could either positively or negatively impact their recovery. It was important to teach appropriate language to use with mothers because of the stigma of opiate use. Instead of calling someone an opioid addict, you would acknowledge they are a person suffering from a substance use disorder just like any other disease.
Since implementation of the program, NICU leaders have noticed during daily rounds an increased advocacy by nurses for mothers experiencing substance use disorder. Nurses are now actively seeking information and resources for the mothers as well as being more open to parent-child interactions and increased flexibility with visitation times. Often mothers with opiate addiction disorder sleep during the day and wish to visit at night for this is what has been their lifestyle for such a long period. It was important that nurses understand that some of the medications that treat opiate use disorder cause sleepiness, and this should not be an assumption the mother has relapsed.
Next steps are to offer ongoing forums and developing required education for all staff in the NICU and within the Women and Infants' unit, which includes the pregnancy assessment center, antepartum, labor and delivery and postpartum. In 2019, the program was awarded the Dr Corinne Walentic Provider Award from Generate Health at their annual award ceremony "Standing Up for Mothers and Babies" in St Louis, Missouri. This award is in recognition of initiatives that impact the culture of hospital nurses through provider engagement and training at the system and individual level that demonstrate empathy, caring and one-on-one engagement.
-Cheri Meador, BSN, RN
-Chonita Krause, MHA, BSN, RN
Neonatal Intensive Care Unit
St Louis Children's Hospital
St Louis, Missouri
-Lisa M. Steurer, PhD, RN, CPNP-PC, CPN
Research & Outcomes
St Louis Children's Hospital
St Louis, Missouri
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