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Addiction in Franklin County

How Franklin Medical tries to help babies born addicted

Suzanne Stoneham, a 26-year nurse of Baystate Franklin Medical Center's "The Birthplace" and Linda Jablonski, assistant nurse manager, demonstraste the process of checking a dosage of neonatal morphine before administering it to an infant in opioid withdrawal. Two nurses are always required to check dosages on all neonatal meds.
Recorder/Micky Bedell

Suzanne Stoneham, a 26-year nurse of Baystate Franklin Medical Center's "The Birthplace" and Linda Jablonski, assistant nurse manager, demonstraste the process of checking a dosage of neonatal morphine before administering it to an infant in opioid withdrawal. Two nurses are always required to check dosages on all neonatal meds. Recorder/Micky Bedell Purchase photo reprints »

GREENFIELD — Last year, of 460 babies delivered in Baystate Franklin Medical Center’s maternity ward, 22 required close observation for possible drug exposure in the womb and seven needed treatment in the form of morphine to ease withdrawal.

These are the numbers compiled by Linda Jablonski, assistant nurse manager in “The Birthplace.” While the number needing treatment is so far in the single digits, it’s a shocking increase for the small hospital.

“We’re really just starting to measure these statistics because just anecdotally ... we’re doing this all the time. We didn’t used to do this but once or twice a year, and now we’re doing it all the time,” Jablonski said.

“Neonatal abstinence syndrome” is the name given to the symptoms sometimes displayed by infants who were exposed to addictive drugs in the womb and cut off with the umbilical cord.

The treatment involves managing withdrawal with morphine, and more, Jablonski said. “It’s keeping them with their families, it’s skin-to-skin contact, it’s teaching the moms how to hold their babies, how to soothe their babies, how to wrap and swaddle their babies,” Jablonski said. “It’s not just that medication thing.”

For some reason not all babies exposed to heroin, opioid painkillers or the drugs used to treat opioid addiction — methadone or buprenorphine — experience withdrawal.

Jablonski said both the reason for this and what will be the long-term impact of opiate exposure before birth remain to be studied.

With or without the research, the immediate harm is obvious to nurses and midwives. “First of all it’s not natural, it’s an insult to their neurological system — physically, chemically. If you spent one day in the nursery holding a baby that was being screened before they started their treatment, you’d know what the problem was,” Jablonski said. And the problem isn’t just babies in pain.

Whether it’s depression, trauma or some other issue, there is an underlying cause to substance abuse by the mother, she said.

“It’s a defense; it’s there for a reason; there’s something wrong in her life, and we want health care providers to help support her to a place where she doesn’t have to use substances.”

The hospital’s response began last winter.

Postpartum addiction

Jablonski co-chairs the Franklin County Perinatal Support Coalition, a group of concerned professionals from the hospital and surrounding medical community who got together in 2009 to address postpartum depression.

The collaboration resulted in what Jablonski called a “Franklin-ized” postpartum depression screening system, with pregnant women screened twice during their pregnancy, then once at The Birthplace, and throughout the following year by their physicians.

Now the Coalition is moving to address the new problem, meeting to discuss the problem with representatives from the Department of Children and Families, Bureau of Substance Abuse Services and members of the local recovery community last spring.

Jablonski has since worked to “Franklin-ize” a substance abuse screening tool for mothers similar to that in place for postpartum depression, and to piece together a referral system through the coalition to get women from the moment they’re able to admit they have a problem into treatment and support.

Nurses are also working to understand what women in treatment are going through, trying to decrease rather than exacerbate the stigma women in recovery may feel. Stigma isn’t the only barrier to women coming forward.

Medical providers are mandated reporters, and must report drug abuse to the Department of Children and Families.

The DCF last year changed its policy regarding opioid treatment drugs. Mandated reporters must still report any substance-exposed newborn, but the process may stop there if the only drugs present are those used to treat addiction, or other prescribed and appropriately used medication, and if there are no concerns of child abuse or neglect.

Related

Series at a glance: Pushing Back

Friday, May 9, 2014

A year ago, we reported that addiction to heroin and its painkiller cousins was ravaging lives in Franklin County.  Now, this new six-day series asks “what can we do?” ... to reclaim those ruined lives and beat back the threat of chemical enslavement. … 0

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