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QHC's Neonatal Abstinence Syndrome

Included in the photo are QHC staff who are affiliated with the Neonatal Abstinence Syndrome programThe birth of a new baby can be the most exciting thing that will ever happen to a woman. But for some women, knowing that they're about to give birth to a baby who could be at risk for NAS can be the most frightening experience of a lifetime.
Neonatal Abstinence Syndrome (NAS) refers to the symptoms that some babies may experience when exposed to certain drugs that the mother has taken during pregnancy. This is often called withdrawal. When a woman is pregnant and receives Methadone treatment or takes a drug such as Morphine while her baby is in utero, the unborn baby is exposed to the drug. On July 2, 2015 the Maternal Child Program at Quinte Health Care, with the support of community partners, launched a Neonatal Abstinence Syndrome program to provide more holistic care to families.
Darlene Stuckless, who is a Social Worker for QHC's Maternal Child Program explained that although there is a lot of stigma attached to the women whose babies are expected to be born with NAS, the majority of the women are middle class, working women who are functioning well. “There's a stigma attached that these women are ‘drug addicts' but the majority of the women who are referred to our program have become addicted to opioids (pain medication) that had been prescribed. When they try to stop taking the medication, they get sick and then go on Methadone,” she said. According to the Provincial Council for Maternal and Child Health, Methadone is the treatment of choice for opioid dependent women during pregnancy. Methadone is often used medically as a pain medication and a maintenance therapy in people with opioid dependence. It is also used in managing severe chronic pain.  “The majority of the women who come into the program look like we do. They have jobs, they're middle class women and nobody knows that they're addicted to pain medication,” added Stuckless.  
The first patient of QHC's NAS program was a 34-year-old woman. She had been prescribed Percocet painkillers from a previous soccer injury and became addicted to the painkillers. She went on a low dose of Methadone in order to stop taking the Percocet and became pregnant. She said that she was incredibly nervous coming into the hospital knowing that the use of Methadone has a bad stigma attached to it. “I was really scared of being judged harshly,” she said. “I was already hating myself for being on it and exposing my sweet baby to it,” she added. When her baby was born, he spent five days in the hospital being monitored and responded well to the program. 
Although the NAS program is new to Quinte Health Care, it has been around for years and is offered in other hospitals throughout Ontario, Canada and the United States. Stuckless said that over time, there have been studies and new findings which have led to improvements of the program. “The common practice was to separate the newborn baby from the mother while they were both receiving care individually. Research now tells us that babies who are at risk for NAS recover more quickly when they ‘room in' with the mother.” Shelley Kay, Program Manager for QHC's Maternal Child Program said that the NAS rooming in program was a project that the staff undertook knowing they could make a difference in the lives of moms and babies. “We are so proud and glad that this project has made a difference. Every mom and baby deserve the best start; right from the start and that is our goal,” she said. Babies who are born with NAS either room in with the mother or are cared for in the Special Care Nursery – that is something that the care team decides. Babies are monitored closely and a validated scoring tool is used to determine if a baby requires medication, such as Morphine, to alleviate symptoms.   Babies room in with their mother unless there is a medical need for the special care nursery or if there are other factors.
Since the program began in July, there have been 18 NAS identified cases at QHC BGH, including one instance where a mother was taking Morphine because of a medical condition that she developed during pregnancy.  “There's been a great deal of fear for the women. There is a fear of being judged and shame, but the feedback we have received from the families that have been through the program has been positive. They feel good about the care and support they've received,” Stuckless said. 
The NAS program, which involves multiple care providers, oftentimes starts with an OBGYN or Thrive worker making a referral to the program. (Thrive is a program that works with women experiencing a problem with opioids). The interprofessional care team includes a Social Worker, Paediatrician, a Paediatric Nurse, and a Pharmacist. Quinte Health Care's NAS program is reviewed every two months by a team which includes nurses, a nurse educator, a midwife, a Thrive worker, a mother who has been through the program and volunteers. “Our volunteers play a very important role in the care of the babies. Oftentimes when a baby is born with Neonatal Abstinence Syndrome they tend to be fussier and the volunteers come in and cuddle the babies. They feel included and I think it's been a rewarding experience for them as well,” Stuckless said.  
Referrals are welcome to QHC's NAS program from all pregnant women who are using opioids or receiving treatment such as Methadone. Ideally, referrals would be received when women are between 25 and 30 weeks pregnant. The family would then be assessed by the team for the appropriate service, rooming in or Special Care Nursery. For more information regarding the Neonatal Abstinence Syndrome program, please contact Darlene Stuckless at 613-969-7400 ext. 2775.