I have been reading over some posts on the topic on this forum today and wanted to start a thread to address several topics. I realize some of the posts I read were several years old and that the info may have been right at the time, or those members may no longer be active. That said, I feel the need to clear some misconceptions. I will say that these issues are near and dear to me, but I am not a medical professional, simply a mother, a birth doula, and someone who does her research. I did consider nursing but at this time realized an HDFS degree alongside birth and lactation support/work is the path for me. Anyway... I got pregnant despite contraception after around two years of methadone maintenance and recovery. I spent a lot of time and discussion making the choices I made. I gave birth to a full term, healthy baby boy who showed signs of severe NAS around 48 hours and spent a little over 5 weeks in NICU. I roomed in with him there for that duration. We breastfed despite challenges and are still going strong at over a year, along with plenty of fresh organic fruits, veggies, soy, grains, and other solids.
1) Breastfeeding- Not only is it "ok" but it is strongly recommended and can reduce severity of NAS in addition to all its non-MMT/NAS specific benefits. Initially the cut-off dose was 30mg by AAP- subsequent studies found that mom's dose had little to no effect on how much got into her milk, and that the amount was so miniscule in any case as to do more harm than good by prohibiting it- thus they got rid of the dose cut-off altogether and now encourage BFing for any and all moms on Methadone Maintenance (given that there are not other considerations that could rule out BFing of course). Now, the link between less severe NAS is unclear, since the amount is so minuscule, some speculate that it has more to do with other protective substances in breastmilk and/or the closeness and bonding providing comfort to the baby than any pharmacological mediating effect. Please, if not already, amke pumps accessible, and trained IBCLCs available daily to help NICU situation mamas learn to nurse- while not officially acknowledged as a side effect all the time, I have observed in my son and friends' descriptions that feeding can be a struggle- pushing formula is not the answer. Get the lactation consultants, the breast pump, finger feeding, nipple shields. We are proof that if mom and baby stick it out with strong daily support it works. My son was either too overstimulated or too tired to nurse, and when my milk came in he had trouble latching. We worked progressively for weeks. It was frustrating at times, but between the nurses and LCs support, and determination, we made it. Please respect mamas who desire to breastfeed and help them to overcome obstacles- well meaning suggestions like, "get some sleep and we'll bottle feed the babe," "just give some formula," etc. are not always helpful and can hinder or halt a breastfeeding relationship. Please defer to the IBCLCs when needed; this is their expertise.
2) Stigma- Some nurses seem very angry towards some of these moms. To be honest, I too feel anger towards moms who abuse drugs that could harm their child (the most harmful seems thus far to be alcohol) during pregnancy. And towards moms who have a baby in the NICU for ANY reason and then avoid being there during that crucial time with their babe (though I too know they have other circumstances which may intervene and it is not my place to judge them either). And I too feel some residual guilt anger and confusion at the situation I was in, but it's healing. I know I did the best I could and couldn't have done anything better/different with better outcome, so I have no regrets, and my son is healthy and happy today. NICU just a fading memory (though at the time, it felt like hell- no offense to the wonderful nurses out there, just that no mom wants to see their baby in NICU to start their life in this world, you cannot even explain it if you haven't been there, though on the other side of the coin I imagine you folks have some good insights better than most) But yes- please understand and do not judge- most mamas judge themselves enough even though they may know in their head they did the right thing, it is still so hard. Personally, I knew in advance this was a risk that could happen, and the odds, chose the hospital w/ best NICU, and roomed in w/ my son until discharge as stated. Some moms with jobs, other children at home, etc. cannot do this I know. Some hospital NICUs do not have these facilities.
Also stereotypes- one nurse said something about "those babies" or something. I know she was just used to doing her job, but it hurt me not to have myself and my son seen as an individual, and the tone accompanying the words. Please think before speaking in generalized terms unless medical info is being given, and know that this is something you've dealt with, but it is a first for most of these parents.
3) Blame- I also feel that any parent who did/does use these (harmful) drugs during pregnancy would be doing so because she couldn't understand or stop-- addiction. And the fact that moms HAVE been imprisoned and punished for such, and not been given help when asked only deters those pregnant moms coherent and willing enough to come forward for treatment. Now, other things- stress, caffeine, nicotine, etc. are harmful, many less harmful than opioids, but there is a stigma with NAS, I think it's undeniable. I also understand that nurses say that babies withdrawing from heroin seem to have an easier time-- but research shows that the risks of this to the mom and baby outweigh the benefits of an easier withdrawal. Of course if babe makes it healthy to term and then needs NAS tx for heroin brought-on NAS/WDs, since it is a short acting opioid, it will be less severe and take less time in all likelihood.
BUT, it poses risks to mom and baby- if someone is about to become a parent, they need to find recovery, not keep using illegal short-acting thus more euphoric drugs, first of all. And second, methadone is the best option safety profile, history of use, accessibility (well that one could be argued, I have real issues w/ the clinic system but that is another story for another day).
Coming off an opiate while pregnant is actually contraindicated, and heroin with its short duration and withdrawals consistently increases the risk of poor outcomes over MMT, so the moms who stay on methadone (if already on it- in my case, contraception failed, I had been sober and stable on MMT for several years) or choose to go onto it from heroin or other opioid drugs, if they want to pursue recovery and continue their pregnancy, are not being selfish or trying to get high- on a maintenance dose, patient is tolerant to all euphoric, analgesic, and sedative effects of the drug. One feels "normal" and level on the right dose. Some people will always manipulate or have poor motives, but I think most MMT moms from my experiences have good intentions and are following the best known medical advice of our time to stay on the opioids for the pregnancy and slowly taper when they are ready (for some right after birth; for some, they need it for life- it depends). I have never felt "high" from my MMT dose (not that it matters, but I am tapering slowly off of MMT at this point in my life, which has some unpleasant side effects but the slow pace minimizes them so I can continue to be a good and functional parent to my son) and would not want to, that is NOT the point of maintenance. Blood tests (though some question their ultimate efficacy) are also used by the physicians to monitor appropriate dosing of the MMT patients.
As for accusations that people combine methadone AND heroin, or other drugs- the clinics make you jump through quite a few hoops. Weekly urinalysis, often observed, random urinalysis call-backs and bottle counts/checks, counseling sessions and groups, etc. They are extremely strict with those policies- you cannot assume most MMT patients are just partying it up, because they really have to meet some strict guidelines, including daily dosing for 3 mos, then every other day dosing for another 3-6 mos, etc. (phase system) and are drug tested (not foolproof, but pretty accurate and well enforced imho). Most people wouldn't go through the trouble if they were just going to get street drugs too or continue other opiates, and most get caught if they do.
4) NAS Treatment- Again I am not a neonatologist, but it seems babies treated with methadone have more complications reported, and much longer tapers needed, which makes a lot of sense, since it has a much longer half-life. I would encourage use of opium tincture or morphine over methadone for NAS babes- yes it is less convenient for nurses and docs due to the q3-4 dosing BUT it, imho, is better for moms and babies. Sharon Dembinski is a Nurse Practitioner and has extensive experience- her site is a great resource for some of this and links to some of the research referenced.
5) Support- I will forever be grateful for the nurses who treated me simply as a new mother needing support, and as a human being who had to make a hard choice. Those who respected that I wanted the best for my son and listened to my input at rounds every day. Which were the majority actually. So- please do not make snap judgments, see us as individuals. There are moms on mmt for years, moms who just got on a few months before birth. Moms who used contraception, moms who were careless, moms who planned their baby all along. Moms who use other drugs and moms who do not. Moms who are serious about recovery and family, and sadly those who aren't. No matter the case, judgment does not help anyone, and a little support and human kindness can go a long way.
I would venture to say I suffered probably as much as or more than my son did with the NICU stay- once stable, I don't think he felt many symptoms (my input was, better a longer taper, whether or not they would discharge us to finish it which was undecided at that point, than to have him in pain or discomfort) but I cried with him every time he cried the first few weeks- imagine going through that as a mother, you are essentially put in a lose-lose, rock and a hard place, and what is at stake is your CHILD. Empathy. I will say that 99% of nurses, docs, and social workers I spoke with displayed a great amount of this, and we are forever grateful that they helped us to get through that difficult time. Thank you. Please know, others, that this makes a lifelong impact and what you do or do not say is remembered. :redpinkhe Even little things- when they'd otherwise be changing or feeding my son, if I was doing it, they kept me hydrated by refilling my water or herbal tea, a few times washed out the breast pump pieces for me, etc. Little gestures to care for mama, who is in turn caring for baby, also go a long way when you have a mom who is there and doing these things on her own-- which I suppose is not the norm, and may cause burnout or nurses getting jaded feeling they are left to deal with these symptoms without the parents input or support- I realize it goes both ways.
Also, please help mamas (and dads) feel comfortable caring for and holding their babies. I was able to wear my son in the sling, eventually get a pass to go out and walk when the weather got nice once a day, do his weights and diapers and all, etc. (temporarily unhook him from the respiratory and heart monitor if I was directly holding or supervising since they did not feel he was at risk- I know some rules were bent for us, but I am grateful and think they helped us have as normal as possible an immediate postpartum and bonding- as normal as a NICU stay can get I guess) I am a competent mother and appreciated help and respect in doing as much as possible myself- but some are not as confident in their vcompetency I know- if you don't know what moms want/expect, ask! I suppose some moms feel uncomfortable or prefer that nurses do things, but I think it important to encourage new moms to bond and learn those skills for at home.
Babies with NAS from methadone (or other opiates I suppose) are NOT often preemies or otherwise severely medically ill or unstable- they are healthy babies who have symptoms requiring a medication taper to adjust to coming off of. The less machines, the less medical hoops to jump through, the better. NAS is unique compared to what most other mamas and babes I saw during our stay were dealing with and what I imagine most of you deal with. Please let parents develop the confidence to parent their child, as they won't have you there to do it when discharged.
6) Discharge- I was with my son 24/7, to the point where they let me take him home once stable to finish the taper (morphine and phenobarbital- we were in the NICU for 5 weeks and stable before this occurred). I know some say that is a bad idea, but if the baby is stable, mom is already doing all his cares in the NICU setting, it is better to be home and settle in, imho. The morphine dose for a baby is so miniscule no opiate addict in their right mind would take it, and since I have disassociated myself from using peers for years and live alone with my child and our pets, there would be no one to even attempt such. I think much caution should be used here, and don't think that it should be done all the time or a blanket policy by any means, but I do think case-by-case evaluation is warranted, pros and cons weighed in individual circumstances.
Also, I had been requesting a meeting to discuss this option, not often done at our hospital, for a few weeks and when it finally came about, the meeting happened without me told/invited, and I was suddenly told, "ok, you can go home whenever, today, we think it's a good plan for you guys." Please please please involve parents if they are present in order to be involved, and give some discharge planning and notice- it is a big transition and involves coordinating others' schedules and family support in many cases. I was pleased to go home but disappointed in the way it happened.
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I do not mean to accuse anyone personally, just felt a need to respond to the variety of older threads on the topic, and to share my experience firsthand, and hope you may be helped by some info and tips from the "other side of the fence."
I am very interested in your feedback, and maybe your list of tips for parents who have a baby in NICU for such a situation in interacting with nursing staff and physicians for the best possible care and experience given the less than ideal circumstances. Some may not agree with all I have said and that is ok, just please keep responses respectful :) This is my first post here but have helped moderate an addiction recovery forum and participated in other forums so I hope it meets etiquette/posting standards.
Best to you all and the important work you do for babes and families! :redpinkhe
