Methadone and NAS- from a mom's perspective

babyNP., APRN · Mar 3, 2010

Thank you for posting this; it does give me hope that some of our drug-addicted parents do want the best for their baby and are doing everything they can to get off the drugs.

I would say that in my limited (18 months) of nursing in a NICU, either the NAS infants haven't had a parent at the bedside ever or the parent was too abusive towards staff and had to be escorted by security. One of those moms did make a turn-around in her life and has been clean for a couple of months, but that's the first case I've seen.

Wishing you well with your work and with your baby and your journey towards a drug-free life :up:

Imafloat, BSN, RN · Mar 4, 2010

Thanks for posting your experience. Your case is different from the norm. I am one who doesn't rush to judge, you never know what people have been through and I am blessed that I chose the paths I chose, because I could have easily gone down another, and I have no idea why I didn't. I am where I am by dumb luck, and I know it.

I do want to let you know though, that the unit you were on sounds quite liberal and I don't want other parents who may read this to think that if they aren't treated this way that they are on a bad unit. My particular unit would never let a staff member, or a parent, take a baby out of the unit for a walk. Breastfeeding mothers are only allowed to have water in a covered container. This is a state regulation. I would hate for someone to read this and think that we were doing this to them because of who they were. The nurses and nurses aides are the one who spend the most time with the patients and families and they are the ones who have the least amount of control in the goings on and rules of the units.

SteveNNP, MSN, NP · Mar 4, 2010

I appreciate the perspective from the NAS/methadone mother's side....

However, I feel like I should echo what others have said. This was a very atypical unit you found yourself in. Thank God we don't see many NAS infants these days, but they are some of the most miserable and heart-wrenching cases you'll see as a NICU nurse. Often parents are nowhere to be found. I honestly admit that I have harbored feelings of resentment toward mothers of NAS babies. It's only natural. As NICU nurses we are engrained with the drive to advocate for and protect our patients. Even if it means protecting them from their own parents. Who wouldn't feel resentment when a mother gives birth to a horribly miserable infant in the throes of NAS due to illicit drug use? or got pregnant while on methadone? It's not my job to feel bad for mom. My job is to take care of baby.

Nearly every NAS infant I've cared for has gone to a foster family or relative. It's usually mom's 5th or 6th child, all in foster care, and all exposed to drugs. It is heartwrenching. They are so miserable. Sweating, crying, shaking....all you want to do is make them feel better.

It would be nice if every unit had lots of IBLCs....some don't even have one. I don't know of any unit that would allow baby off the unit, off a monitor, with a parent. I've also never worked in a unit where a baby is sent home ON methadone or any controlled substance to the care of a rehabbing parent. EVER.

I consider myself a patient advocate, I spend lots of time encouraging breastfeeding, etc. But there is only so much you can do to make mom and baby happy. More often than not, the baby is frenetically crying, just wanting his meds and some milk, and mom wants to breastfeed. God bless the patient nurses who can sit and listen to a miserable baby.

I don't mean to sound like I am judging you, or the circumstances surrounding the birth of your son. All I can say, in honesty, is that I am here to care for the baby. I can definitely take mom's requests into consideration, but baby always comes first, even if that means making mom mad because I won't let her try and breastfeed a screaming, miserable baby for an hour. Your situation is unique... the majority of moms with NAS babies, in my opinion, have in becoming pregnant while ingesting a neurotoxic, illegal (in most cases) substance... lost the right to direct the care of their baby. Call me "anti-family centered care" or whatever, but that's what I believe.

I am glad you and your son are doing well. This is just what I believe....my own personal perspective.

TiffyRN, BSN, PhD · Mar 5, 2010

Unfortunately unlike SteveNNP we still see plenty of drug exposed infants. In the 2 weeks I have personally cared for 2 different NAS infants. I bet our unit always has at least one NAS infant at all times, when we don't have 4-5 at a time.

I know I'm not everyone but I really do evaluate each mother/infant pair individually (for all infants, not just NAS infants). I can say in the last 7 years I have encountered 2 such sets that sounded like yourself, stable caring mothers who placed their infant's needs above their own. Remarkably one was a 17 yr old girl who only went on MMP when she found out she was pregnant. I credit much of her unusual maturity to her own caring loving mother as well as her own personal strengths (yes, I'm speaking of a former heroin addict).

I really appreciate your thoughts and some accommodations that helped you and your son would be so doable. I'm not sure I can convince our docs to allow breastfeeding but almost none of our NAS infant's mothers seem interested. Also, very few of our NAS infants have mothers that visit regularly. We often allow a stable infant to "day room-in" with parents if they are pretty stable, and most NAS infants do not really require 24hr cardiopulmonary monitoring. We nurses unhook them all the time to send them on walks (with staff) throughout the unit, or to have the front secretary hold them for a while, we even have a stroller.

I read your post with great interest, you are very unusual. Most of these moms are not there to hold their infant and go through the infant's miserable withdrawal with them. It is left to us nurses to hold and try to comfort these sweet innocent suffering babes.

I understand your pregnancy was unplanned, but when we see moms coming back for their 3rd NAS infant. . . And I've personally held 2 of her babies. . . And mom has never weaned her personal dose (in 4yrs). Maybe being compassionate for the mom is more than my brain can wrap itself around.

Once more, I cannot tell you how much I appreciated your input from the mom's side. I could only wish that all the NAS infants I've cared for had the same support. I know that you will appreciate the NICU nurse's perspective. It sure never hurts to emphasize that it is our job to be respectful to all.

MamaAndDoula · Mar 5, 2010

Thank you for your thoughtful replies and respectful comments, insights, and even disagreements or concerns. Ok and apologies in advance for the LONG post; I tend to be very verbose at times, hope 'tis somewhat legible and makes sense and doesn't scare too many away :lol2:

I understand that I may be in the minority, but just wanted to point out that not all moms with NAS babies are using illegal drugs or don't care for their baby; that said, I imagine you must see some heart-wrenching cases.

@Tiffy, that is a HUGE number, that must be stressful!! I can see where you are coming from with some of those feelings- maybe the key is to let that hurt/fear/past experience show until you get to know the individual? I am really happy to hear that you do try to approach each mom-baby dyad (or mom-dad-babe triad) as individuals with different lives and needs, and that you do feel some of what was so helpful to me could be applicable to your hiospital and/or practice- that is great to hear!!

Even without NAS or addiction/dependence- even if the issue is something else- I think it can be hard for some parents to have a babe in NICU (not sure if it is easier or harder knowing in advance that it might happen as with me- though it definitely fif not prepare me for the reality much as a tried to do so..) and they may then detach because they feel they are not needed, or fear getting attached and losing their baby (when the health condition is more severe). But I also think the inner guilt of an NAS affliced child (even if they followed their doctor's orders to the T, know logically they did the safest thing and that it won't affect babe's long term development, etc.) you are not thinking with your head in that situation- you are hurting with your heart- for me, I had to get past that and say, my baby needs me and nothing is going to stop me. I was then pleasantly surprised by the compassion of most nurses towards us and little gestures like I said, and tried to show my gratitude as well, it's a two way street though I know you are also doing your job!

I personally, like I said, used contraception, not planning to start my family quite yet at 22 when I gave birth, but I think I made the best choices I could make in the situation and am currently choosing abstinence from intercourse as "birth control" until I am off the MMT completely, following my current ongoing taper, and to be with someone whom I love and want to continue my family with and would want to be a father figure to a child(ren) in a healthy way.

Sadly, my son's biological father, while both a family and personal friend of nearly 10 years and a great-hearted person, is also an addict and during our brief period of dating (it was sort of a rebound for him I think as he had just ended a relationship, and I made some poor decisions as I should have realized it was not a healthy relationship dynamic) has since relapsed to alcohol addiction and heroin abuse/addiction, came to a visit under the influence, so I have had to tell him that I insist on counseling and cannot talk with or have visitation with the babe until he is is back into a recovery program and we have done some family therapy to determine what is safest and best. I actually did consider adoption- I ruled out abortion based on doctors optimism and my own beliefs (I am pro-choice, but that's not relevant) but I think I was also slightly misled or maybe just naive in that I did not imagine it would be as difficult as it was, for either one of us.

I actually did not decide until about two thirds of the way through my pregnancy that I would parent for certain, nor did I purchase an baby things until then or announce one way or the other, just that i was considering what was best to those closest to me.. and had a potential adoptive family picked out- though they knew I hadn't made a set plan and that ideally I would parent my child if i could do that in the healthiest way for the kiddo (they actually adopted another baby soon after, and now the kids have playdates or I babysit sometimes- they are great role models to me as parents). But in all aspects of my pregnancy, I considered what was best for my baby and do not think it fair to choose to parent if i am not willing and able to be the best mom I can be with support of family and community and meet my child's needs. I saw an unplanned pregnancy counselor along with continuing to meet with my AODA counselor, and finally saw that I could and would be a parent who could meet his needs with the support networks in place (great family near-by, etc.)

Unfortunately, I do question my choice now in one respect, with his bio father. I had been told by him that I would be parenting alone, and as an HDFS major, I have done much reading and learning about family structure, stress, child development, etc. It seems that the "mother and father" thing is outdated- less so than actual structure is the quality and quantity of positive relationships, needs being met, and stability. I thought this was the case with all my extended family on board, my degree almost done, and knowing that I had always wanted a family, was stable in recovery mindset; it would just be a bit earlier than may have otherwise been ideal (ideally of course I would have wanted to be done w/ school and married or in love with a partner, or single and used a sperm donor, but that too is another discussion). Now, I wonder since the state I live in is very big on father's rights, and I have no right (nor could I justify wondering if I did the wrong thing by preventing him from visiting now that he changed his mind and wants to..) BUT I wonder if he would have been better off with stable adoptive parents, gay or straight, single or married, but stable in having one parenting unit and not a parent actively addicted to an illegal drug etc. He (my son) already has genetic predisposition to addiction, and as a parent, it scares me that I chose the wrong man to be a father, and once I realized he changed his mind and intended to be part of my son's life, well, I still fear for what harm could come, and know that if and when he is ever under the influence around us again I need to call the police (I was in denial at the time, questioning it, but looking back and later he admitted it; it was quite clear..) Though I have also read research that the impacts of a loving and stable relationship with one parent and/or another adult can cancel out the increased addiction risks caused by genes; I have to find where I found that blurb, have been meaning to look up the actual study as it was just a little blurb I read or maybe an abstract, don't recall where, there were four measures specifically accounted for which negated the otherwise increased risks.. anyways, I hope to be totally honest with my son about the hard choices made, about the need for him to be careful and open communication at an age-appropriate level, and hope he forgives me and accepts his family history, good parts and not so ideal. His paternal grandparents are now also lovingly involved and great support people as well, though of course they have concerns about their son (he moved out of state when my son was a few mos. old, to try to straighten himself out and finish his education, so he visits every few months).

I do have to say that yes, as a nurse your job is to care for those babies, and if the parent is not doing it properly or at all, you get protective and may feel angry/hurt- I imagine it is a fine line for you, getting emotionally invested, but not getting burned out. My doula work has shown some similar lessons, but not so far to the degree of life and death or possible awful long term outcomes- just feeling powerless to stop certain things that i know are not consented to by the mother or that I know may not be necessary but are done out of habit, or unexpected outcomes like cesareans, people in the room (family, friends, nurses, docs) who do not seem to have mom's/babe's best interests at heart and I do get protective of my mama clients. I can see how in a NICU setting, and knowing that neonatal withdrawal is tough on babies, and if your experience has been that the parents tend to be less than responsible, then I can see where that attitude comes from. I am just glad I had the chance to be treated as an individual and get to know people that way at the hospital I birthed at and NICU we stayed at. I wish it could be like that everywhere.

****Now-- I have to say this in response to one of Steve's points-- I also do get extremely offended when medical professionals (as a birth doula, a parent, and in other settings, culturally and in general too) imply that anyone is more concerned with that child than that child's mother herself. I cannot imagine any nurse or doctor (while like I said, we developed some great relationships and teamwork, and our main nurse definitely loved and cared for him extensively, we have dropped in to visit a few times and hope to continue keeping in touch through his childhood with her). Maybe you see this, especially when moms are on illegal drugs or abusing the concept of maintenance, and that is sad. I do know a lot of moms get on MMT simply because they get pregnant, and I know a lot of men and women are careless with contraception when this is essential (especially if you drink alcohol or use other substances that are teratogenic or cause illness or withdrawal)- I guess I may also be an exception since I was stabilized in a non-drug or alcohol using lifestyle, with the exception of the MMT medication (which as I said creates dependence but negates most of the negative behaviors of addiction- big difference between those two seemingly interchangeable words..), and was 100% committed to a healthy lifestyle. I am a vegetarian, use organic clothing and bedding when possible, use non-toxic toys, follow the guidelines for breastfeeding, etc. and monitor my son's needs closely. I see that many of you have seen that some moms (NAS babies or no) are not as careful with their children's health. And as a poster said, it is sad when you see someone who has gone ahead and had MULTIPLE babies with NAS- I would never be able to do that again, which again is why I have committed not to take any percentage of any chance of pregnancy while on MMT and not ready for another child; it is simply not worth it to me, and not fair to the child in my opinion. I too as stated harbor anger towards moms whose children have these symptoms and then leave the nurses to care for them- I found with my son, he was cared for well, and as long as he was with me and/or his grandma/grandpa, swaddled, rocked, in the sling/pouch, breastfed on cue, etc. he did well. He had some normal newborn fussiness and gas, which looking back, every time he fussed a little I felt awful and thought he was suffering, but his scores were low/normal and the nurses assured me that in their experience, some over 30 years, this was not suffering related to the NAS.. but yes, NAS babies do need a lot of supportive care and I can see how without a parent there, whose role it is, it stresses nursing staff, maybe creates some resentment? But, on the flip side, if this is pre-emptive, it can keep parents away and perpetuate the cycle, is my point...

Now specifically with breastfeeding, I will say since someone said they'd have a hard time getting this implemented/ok'ed by docs- the AAP and much research points to the fact that it is not only recommended in general but highly encouraged for moms on opioid maintenance. Maybe this info (and/or the mom making a plan during her pregnancy with her babe's chosen ped or FP doc) should be provided to them. I am happy to link or share some info if any of you don't have it and would like some empirical data or position statements from influential medical organizations to help the docs understand that what is evidence based care now definitely includes breastmilk for the baby with NAS and mom on methadone.

Now, if the mom won't put the effort or doesn't want to-- or if she is on other drugs or meds that are not safe, then of course she shouldn't. But in my case, I had to start by syringe feeding pumped colostrum, then finger feeding and pumping my milk every 2-3 hours 24/7 then each time, would latch him or attempt to do so before and/or after- thus, he was learning to nurse, but also getting the hydration and calories needed to maintain his glucose and weight re-gaining. We also had to implement a nipple shield as he was either too tired or too fussy to latch oftentimes; this was a big help and helped him latch. I went through weeks of noting every feeding, weighing every diaper, weighing before and after nursings when he transitioned from any pumped milk supplementing to exclusive BF, etc. It does take a lot of commitment but if you know that is what is best for your baby you do it. That is what being a mom is.

Now, I don't think I COULD have done no matter how much I wanted to without the extremely supportive and well educated nursing staff with regard to BFing positions, latch, techniques, and general encouragement and the IBCLC's support, plus pregnancy breastfeeding class and readings and La Leche etc. I was very committed to making it work and learned all I could about possible issues and solutions.. I do think BFing is so important, not just for NAS but most clearly for premature babies, and others, and also non-NICU neonates-- for all babies when possible, which is most of the time in my opinion though some common well intentioned but misguided advice can cause a vicious cycle of interference with the normal cues of the baby (scheduled feedings) or law of supply/demand (encouraging a mama to skip feedings more than occasionally and not pumping instead if she does, supplementing with formula when not needed- supply -if low, it generally is not can be boosted w/ fenugreek and other herbs which work amazingly well, and other options, some pharmaceuticals, etc. and the virgin gut can be damaged by just one feeding of formula, so for some well-read moms, yes it is a big deal (on the other hand, I don't think that a mom will be so intent on bf'ing that she would refuse formula or milk fortifier if her baby were ill or glucose dangerously low- we just want what is best for our babies- but had I not stood my grounf, they would have wanted to supplement, and it was never needed. In fact, I procured donor milk from a bank as back-up since they kept telling me things like I could never make enough colostrum to keep his glucose up until my milk came in, all NICU babies get or need formula, etc. which is NOT helpful- nothing wrong with it when needed/helpful, but if a mom expresses a desire for exclusive breastmilk, please do try and support that even without lactation consultants (I cannot believe some hospitals don't regularly staff these, esp. for NICU!!?) I absolutely think hospitals need to prioritize having these resources available.

I did get to meet with an IBCLC daily for that duration. She said most other moms were not there, just left pumped milk. Now, I also understand you can only do so much- for example, finger feeding may not have been an option had I not committed to rooming in 24/7 and doing this process mostly myself, as I understand nurses are busy and it takes longer. But on the other hand, an example a PP mentioned, if a mom spends an hour struggling to nurse/latch her baby, likely frustrating herself and her child too, make sure she is at least pumping and that way she can at least learn to finger feed and/or use an SNS- another trick I learned was to use an oral syringe and put some pumped milk on my son's lip and on my nipple, and keep spraying a bit in his mouth until the let-down and he started getting milk from the breast directly. Things like this, knowing there are things to try, can be really simple sounding but really encouraging to the mom. If there is any question at all and a mom definitely wants to BF, I encourage her to be provided with a pump kit and encouraged to pump immediately. Even if not LCs at the hospital, maybe a hospital could compile a list of private LCs, postpartum doulas, WIC resources, pump rentals, the local La Leche, sites like kellymom.com etc. If the hospital cannot or will not provide this consistently, it might at least be nice to have an info sheet in the new moms's folder on this topic? Let them know insurance often covers this fully for a NICU babe- pump rental that is, so if you don't have this at your hospital she can usually get one free herself for that duration.

I know my son could have taken bottles of pumped milk. I, however, along with the IBCLCs, felt this finger feed method and some SNS later would help his latch and that a bottle nipple could hinder the learning curve, so we avoided artificial nipples for feeding. On the other hand, I did make compromises when needed and was not a pain in the butt to the nurses as some of you might be thinking lol. I initially wanted no sweet-ease or pacifiers, but when I realized it was something that was helpful and comforting for my son, I consented and we used this until he stopped needing/taking on his own about a month in. I also ok'ed a nurse to try a bottle if needed when he was frantic early on in our stay, but it didn't help anyways and he wouldn't take it.

I do agree with some points also about most NICU units not allowing babies to go outside like that in spring or summer, not sending moms home to finish dosing the morphine and phenobarb, etc. Not that it is bad if a unit doesn't- that is definitely the exception, NOT the rule, and I did not mean to imply moms should expect such things, I know some rules were bent in our case. I just did not want my healthy term baby who happened to need the taper for NAS being restricted in ways that were not helpful to his early development, which is why I advocated for this- some of my requests or discussions were turned down, and I accepted these limits graciously, but was happy with the accommodations that were made for us. But yes, to clarify-- most NICUs don't let you go outside until discharge or do home finish of the taper (in our case it had gotten to the point where I would set an alrm or even occasionally have to remind a nurse to give the meds or help give it, so they knew I was able as I had been part of the process all along- plus had they done a faster plan he would have jumped off already- it was me who wanted to be cautious, after the first wean attempt after he was stabilized was awful, so I wanted to do it more slowly and have him jump off from a ower dose than they typically do, and they agreed to this, under monitoring by his ped who as stated was involve in the NICU and felt comfortable overseeing this, as well as keeping in touch w/ the pharmacist who makde the taper calendar for us to follow.

Back on track-- yes, to clarify, also, most NICUs do NOT have private rooms either, which I think should be a priority in general, as the ward-style NICUs seem to be more stressful for parents and babies and allow for less intimate bonding and less time spent there (not just NAS)-- any input on this, or nurses who have worked in either type/both types? I had choice of hospital personally and picked the one with private rooms over the ward style because I felt strongly that we were in this together and that if he did have NAS it was my job s a parent to be right there with him- I cannot imagine it being any other way, and can see how you nurses would be saddened and angered by moms who leave their baby like that. I do want to point out though, that knowing addiction personally and through loved ones, it is not a choice- most of us have tried an addictive substance- opiates for dental surgery or back pain, majority do or have drank alcohol, those are the two biggies that come to mine- no one WANTS or chooses to become an addict- trust me, it is not at all fun. It is an illness. These moms likely 1_ Feel stigmatized and shamed and guilty, and/or 2) Are just not mentally or physically capable of helping out with the baby or dealing with the situation at that point-- not that makes it okay at all, just that I don't think any mom would make a conscious choice to abandon her baby to nurses sole care, as wonderful and caring as you all are to to the babes you look after. I also believe that some may have had a traumatic birth experience or other life experience and may be suffering from some postpartum and/or situational depression, and this needs to be addressed. I think any interventions- not confrontational, but things like doing a drug screen is acceptable (for me, I consented and was told it would be done, but i do not believe it ever was..?) and mainly counseling provided by the hospital chaplain and/or social worker, as well as the in depth interview usually done by the SW for any mom on a medication like this (is this standard policy??)

I would be interested to hear more thoughts from PPs or new posters, and to learn more about how your hospital in general, and yourself and your colleagues talk, feel, and act towards these babies and parents. It saddens me that it seems the majority of experiences are negative though :crying2:

I hope that improved intervention and education services, especially during pregnancy but also especially if and when the baby comes to the NICU (immexdiate postpartum time is so crucial for mom and babe imho)- what do you think might help, or do you think some of these women are just not ready?

And what of those who are, who have potential, who want to and are able to work towards being healthy positive parents? do you think you could see past the basic circumstances and stigma and reach out to her and help her connect with her babe?

Of course there are moms who are completely irresponsible (in my view not due to moral failings but due to the nature of the beast of addiction) but those moms I have encountered here: http://www.methadonesupport.org/Pregnancy.html show some wonderful and inspiring hope to have a positive and healthy future for their families, and many are either pregnant and use the board for support, or some of us use it to help newer women know what to expect and how to minimize the risk of NAS or its severity (i.e. dose is irrelevant, withdrawal is harmful, split dosing is helpful as it keep blood levels more constant for the baby's exposure and less risk of WD, encouraging breastfeeding, etc.) There is a section for professionals but very inactive. Sharon has developed a protocol specifically for NAS babies at the hospital she used to work at and may be a good resource for some of you. I also think that a program that involves prenatal care as well as postpartum care is best- I had to sort of put this together myself, but between the support forum linked to, discussion with my perinatologist and midwife, as well as my AODA counselor and pregnancy counselor, talks with my family and trusted loved ones, research, etc. I was able to plan somewhat for postpartum knowing the stats and risks and likelihood that we may end up with a NICU stay (though I must admit apart of me had that invincible attitude of, I split my dose, I plan to nurse, I follow all recommendations, of course my child will be healthy! but i also knew this was not realistic, and turned out despite the best efforts, my son still had NAS) I know mamas on 15 mg/day with NAS babies, and mamas on over 200mg/day without it, so it is unpredictable for certain! I also met prenatally with one of the neonatologists and went over my questions and get a copy of their basic NAS protocol (I think very hospital and OB/MW should have this in writing and provide/discuss to pregnant women on opioids, be it addiction/street drugs, maintenance meds, Rx for chrnoic pain, whatever- this has to be didcussed rom the get-go and followed through on.) I did also make a birth plan and written care plan that included the possible conplications, symptoms, and contingencies should my son need NICU care for more severe Finnegan scores, which he did wind up needing after about 48 hours.

Basically, I just wanted to point out that when one looks without that initial lens of judgment, one can see individual cases where exceptions can maybe benefit mom and baby, and I am so grateful they saw this for us. Of course I had extensive interviews and meeting with the social worker, and of course I talked extensively with the neonatology docs and the pharmacist, and followed up as requested with his ped who was also involved to some extent while we were in NICU. If you have any doubts, as a medical professional, I imagine you could not in good conscience send a mom and babe home with these meds. If hospital policy forbids it, I don't imagine you can bend certain rules and get yourself in trouble. But I am just trying to point out that things that are in place for very ill babies in the NICU, many who may be at risk of lifelong health issues or death and attached to a lot of machinery, some of this doesn't apply to a well stabilized and well cared for NAS baby, and so I do think some exceptions and different protocols should apply. I also think that the reason some moms do not come around more is that they feel that judgment (I had only one really bad experience with a nurse I can recall- my mom was worried about me expending so much energy and getting so little sleep- I went home for a total of less than six hours during those 40 days in NICU- and being a mom too, she worried. So she told me to sleep and she would rock my son and do one of his finger feeding with a nurse's help. The nurse snapped (at my mom, I overheard as i was in the same room on the pullout couch/futon behind the curtain), "if pshe] is going to be his mother/parent him at home like this, she needs to be the one doing this, not you." It was really rude and unnecessary, and especially since my mom was trying to help me and was worried for me and my sleep/health, and since I had done 99.9% of all feedings, diaper changes, etc. day and night, it was really mean- I felt she would never say that to any non-NAS mom, most of whom had the nurses doing much more cares for the babies (partially due to necessity and severity of condition obviously) than me missing ONE single feeding at my mother's behest to get caught up on sleep (I have a sleep disorder and sleep is rather important in my case- in all cases really, but with my condition I do need to get regular sleep or my memory, alertness, and immune system are negatively affected- it is a neurological form of sleep apnea, central sleep apnea with related hypersomnolence- for which I actually DID come OFF my med Provigil despite the doc saying oh no, that I could stay on it, because I did not want that risk, and there was potential risk with continuing it, versus no risk to the baby coming off it (unlike coming off a prescribed opiate- the baby is dependent shortly after you get pregnant- by the time you know you are pregnant, what's done is done). I respected the nurses a lot and it must be such a difficult situation at times- I just wanted to point out my own experience and that there can be a flip side, and even then, it is not always black and white.

Sometimes what is done is done, and if the mom seems to show any interest in being a good mom to her baby, please don't push her away despite your feelings- she doesn't deserve the brunt of your past experiences, though I also understand this functions positively as a medical professional since your past experience can inform future practice in helpful ways.. if it is an adoptive placement or obvious CPS case that is one thing- sad for everyone bu may be needed- but if the mom is actually doing ok on maintenance, and plans to parent, she needs support during the vulnerable postpartum time as a new mom, and peopl to help you "learn to ropes." I'd nannied for ten pls years, but being a mom is a totally different experience, obviously lol.

Thanks again and please keep the comments coming, I really appreciate your input and perspectives and responses from the other side of the fence.

littleneoRN · Mar 6, 2010

(on the other hand, I don't think that a mom will be so intent on bf'ing that she would refuse formula or milk fortifier if her baby were ill or glucose dangerously low- we just want what is best for our babies

Thanks for your perspectives. I agree with much of what you have said. We get moms who are on methadone both for history of illicit drug use and history of long term legal narcotic use for chronic pain. Often I don't know which unless she is actively using again until I sit down and read the history and physical, which is often after I meet the mother. So I get the benefit of meeting each family as an individual.

That said, I agree with other posters that you are unusual (not only for a mom on MMT but for moms in general) being so well-read and informed. Your level of commitment to being involved in your baby's care is unusual for moms on MMT that I have met. You made several comments about moms just wanting what is best for their babies. However, unfortunately, there can be lots of misperceptions of what is best for a baby. I picked this specific quote because it can apply to lots of babies, not just NAS. I have admitted multiple babies to the NICU for profoundly low glucose that had been dropping over time who parents have refused formula or glucose water because it is unnatural and not best for baby. Some prefer their infant be admitted to the NICU and have dextrose given IV. Of course, this also leads to a septic work-up, antiobiotics with the associated risk of side effects, increased risk of infection, increased costs, and separation of mom and baby. Is this really best for the baby?

I also have complete respect for parents who refuse pacifiers (NICU or otherwise) if they are committed to being there to comfort and support their infant. But some moms who refuse pacifiers also send their baby off to the nursery for hours at a time. If the baby is happy and sleeping well, fine. But what about those who are frantic for some kind of comfort? Some moms with babies in the NICU refuse pacifiers but either choose to only visit infrequently or are unable to visit. We don't see or hear from some moms for days (or weeks). And that's not just recovering addicts. Some of these babies spend more of the day crying out for comfort (whether it be being held or non-nutritive sucking or whatever) than they do happy. Is this really best for the baby?

There are people who despite our best attempts at education want things that are best for them (parents) rather than for themselves. "I want to hold my baby." (who just came back from surgery and barely tolerates being touched to have vital signs checked.)

Once again, I respect you, your commitment to your child, and your place as an individual. I just want you to know that you truly are an individual. There really are people who have serious misperceptions about what is best for their baby or cannot separate what is best for them vs. what is best for their baby. The mothers who are as committed to breastfeeding as you are in the minority, MMT or not. You are a dream parent in my book, but there's a reason why that's a dream. It's not my everyday reality.

BabyLady, BSN, RN · Mar 14, 2010

The OP is a one-in-a-million Mom.

I live in an area where 50% (yes, 50% or even higher some weeks) of our babies in the NICU, are positive for drugs at birth or Mom tests positive.

We are also about an hour from a Methadone clinic and you are absolutely correct that stopping opiates for addicts, cold turkey, is contraindicated and even tapering down can be of increased risk of fetal demise.

I am a relatively new nurse, but frequently take care of drug babies because I'm known for being very patient with the families and the babies...they are generally pretty good feeders, so I don't mind taking them.

However, I do want to point out some things I have noticed, and this is only from my personal experience and is obviously not going to apply to every Mom and

Baby, but only what I have observed so far.

1. I have noticed that Moms are generally honest with their drug use, which surprised me. However, ever single one has claimed that their OB told them that their drug use ie. Methadone, would not affect the baby, or minimally.

2. I have never seen an NAS kid with a mother who breast fed it...we can't even get them to bring clothes for the baby half the time or to be available to hold the infant for the endless hours of screaming.

3. Most of them blame the formula for their baby's vomiting and diarrhea....despite every nurse on every shift reminding them that it's a part of NAS.

4. All of our Neo's, with rare exception, use Methadone to ensure more constant levels in the blood....trust me, they could care less about the nurse's convenience regarding Morphone.

5. Most of these mothers feel that we neglect the baby's because we cannot hold them constantly when they are screaming...they don't seem to understand that staffing does not permit us to do this, as we have other babies to care for, however, we tell them they are welcome to come hold them or authorize family members to come.

6. None of our Neo's will send a baby home on maintenance therapy....keep in mind that virtually all of these mothers are addicts by CHOICE (that means recreational drug use lead to the addiction, not because of needed pain meds)..we have to be sure that the BABY is getting the meds, on time, every time and that they are not being diverted. We frequently have Mom's that ask for this, and have been told that the answer, per policy, is no with zero exceptions for any reason.

7. We don't "push" formula on these babies...in most cases, we have to hold it back to keep them from over feeding and thus, projectile vomiting.

8. They get mad when the hospital social worker has to inform them that CPS has to be contacted not only per policy, but per state law.

I am one of the few nurses that will sit down with the parents and go over the NAS system with them and tell them what to expect...I refer to their babies as "withdrawal" babies, not a "drug" baby.

We never discuss the scoring at the bedside or the fact the infant is on maintenance if Mom brings in family members or friends, unless she brings it up first. Many times they have family members that question why a full-term baby is in the NICU, and I advise them to say "for feeding issues"....it's generic and many like this idea.

Sometimes the level of expectations of these mothers is not reasonable....I am blessed with the fact that they know that the withdrawal symptoms are part of the process...however, you have this handful of mothers that "demand" that we 'stop their kid" from crying and trembling and accuse us, as nurses, of neglecting their baby or not caring about it.

RachelIrene · May 7, 2010

I am a pregnant, CLEAN, mother on Methadone and would really like to thank you for your post. I have had so much negative feedback from people who despite the facts, feel I should've tapered off while pregnant and am a bad person for deciding to keep my baby. I also wanted to thank you for your suggestions to new parents (as I) and to nurses and health care professionals, as it is my 2nd largest fear (next to my baby's well being, ofcourse) that the personelle will treat me and my baby differently because of MMT.

I also wanted to note that you're correct on saying that most MMT patients aren't partiers, but as in everything, there are people who abuse it. You had stated that at your clinic you have to dose daily for three months (and maybe you'd meant this) but at my clinic we have to dose daily for three months of clean urines (screw up and the 3 mths starts over), then you get your weekends (dosing 5 days a week), and 3 months from there you get your tri-weeklys (Mon, Wed, Fri).

It's just nice to see someone who is finally REALISTIC about MMT... not believing it's the greatest thing but not the worst either and refreshing for your opinion to be unbiased, despite the fact you're on methadone yourself. You deserve a pat on the back. You give methadone patients a better name by being educated, clean and sober, a good parent, and show others that methadone is a far better choice than street drugs. Thanks again because like I said, as a pregnant methadone patient, there aren't too many of them out there.

sunshine1216 · Sep 5, 2011

Mamandoula,

I am so glad you took the time to share this experience! I am a RN in a special care unit and often care for infants going through withdrawal. First of all I LOVE that you mentioned that some nurses stereotype when you said a nurse said "those babies"....that angers me! I ALWAYS make a point to know every baby's first name and I always call them by their names. I think it is AWESOME that you spent time caring for your baby. I think a problem is that so many moms seem so surprised that their baby's go through withdrawal. I don't think the Dr.'s prepare them for this. I have really been thinking of trying to do a project on this to put something together that is informative for any mom taking any substance that could cause the infant to go through withdrawal......I always try to encourage moms to spend time holding their infant in a calm quiet dark room. I often find many moms seem to feel overwhelmingly guilty and do not spend much time with their baby. Now of coorifice there are many moms with other children and it makes it difficult to stay in the hospital with their baby. Most baby's I have taken care of that went through withdrawal were from Subutex, and a few from Methadone. Where I work we do an abstinence score every 4 hours. We medicate with Tincture of Opium in needed. It is wonderful you breastfed your baby! I also find that many moms seem nervous about breastfeeding because they think the meds could harm the baby. BUT if anything breastfeeding can help just as you said....and also all the benefits of breastfeeding for mom and baby and bonding!!!! I think part of the problem is exactly what you said, some nurses stereotype. It is very sad and something I am hoping to change in my unit! Thank you again for sharing your story! It is nice to see things from a moms perspective

sunshine1216 · Sep 5, 2011

After reading everyone elses posts I thought I would say one more thing. I do agree that your story is not the norm.....but maybe with better education and preparation it could be! Like I said in my last post moms tend to feel so guilty and I think that is why many do not spend much time with their infants. Now I am referring to moms on a treatment plan (Subutex or Methadone), not illegal drugs. I can definitely respect anyone taking the initiative for treatment. These baby's require extra tlc and I just think it is great that you bonded so well with your child and you provided that extra tlc. It's tough as a nurse to have parents spend minimal time with their child, I personally bond with these baby's when I take care of them for weeks. I love all the baby's I care for I just feel it is so so so important for parents to bond with their baby's.

trclilone · May 11, 2013

It is great if the mother wants to get treatment I praise that myself but let me explain some stories are heartbreaking my grandson was born a week ago n suffering withdrawals from subutex.. its an awful sight and so heartbreaking for this innocent child to go thru this ...I know in long run he will be fine but he shouldnt have to go thru this n to hear the mother state I was addicted to opiods and this was better option for baby because unknown what effect subutex has and minimal if any treated for a few weeks and then he is fine like its perfectly normal....and to say insurnce pays for it ....I read up on subutex basically it is replacing addiction with something similar that cant be stopped...it mimics drug choice...I dont feel this should be prescribed to pregnant women there are other alternatives....I know because I watched it with first pregnancy she just quit and baby was healthly and no withdrawals ...this time she didnt say anything until baby started withdrawals....luv my grandson