Woman comforts newborn baby in incubator

Supporting Mom and Baby in the Opioid Crisis

During their first weeks alive, babies who have been exposed to opioids while in the womb live in a state of overdrive as they go through withdrawal.

The smallest noise can set off their high-pitched cries. Too much light can irritate them. They’re often hard to console.

Even their nurses, who know all the cuddling and swaddling and shushing tricks, find themselves asking for help.

“We think of how these parents would be doing that at home. If they don’t have a support system established and ready, they’re not going to have anyone to hand this baby off to if they are frazzled,” said Jessica Pelletier, an assistant department manager at the Regional Neonatal Intensive Care Unit at Sparrow Hospital in Lansing.

In Michigan and across the country, the prevalence of babies born physically dependent on opioids – called neonatal abstinence syndrome – continues to grow. The smallest, most vulnerable population impacted by this public health crisis now account for about eight out of every 1,000 births in Michigan, as of 2017.

In the Upper Peninsula, opioid use is even more pronounced. In 2017, babies born with neonatal abstinence syndrome accounted for 30 out of every 1,000 births in the Upper Peninsula, nearly four times the statewide rate. Many newborns with neonatal abstinence syndrome spend the first days of their lives in an intensive care unit, miles and hours away from their mothers and families, because there is only one hospital in the U.P. with an intensive care unit suited to treat their needs.

For health care professionals, early pregnancy is a critical time to reach women with a substance use disorder, and evidence indicates medication-assisted treatment is the best way for both the mother and child to have the best chance at success.

But medication-assisted treatment means a woman must receive her dose of methadone or buprenorphine in-person at a treatment clinic daily or weekly – which often must continue after the baby is born. For many women as they juggle jobs, transportation challenges and other responsibilities, this presents a huge barrier to seeking prenatal care, and to being fully present once the child arrives.

Confronting these issues takes creative thinking and unconventional methods. For the doctors and nurses on the front lines of the crisis, the opportunity to enact change is glaring.

“We could really make a change in the next generation,” said Dr. Jennifer Hoffman, chairwoman of the Obstetrics and Gynecology Department at Sparrow Women’s Health. “Nobody really sees how great an impact this opioid crisis will have in 20 years.”

To help health care providers address the growing crisis of perinatal opioid use disorder and neonatal abstinence syndrome, Blue Cross Blue Shield of Michigan, Blue Cross Blue Shield of Michigan Foundation and the Michigan Department of Health and Human Services are partnering to fund local innovative solutions through a new grant program, Addressing Perinatal Opioid Use Disorder. The program supports organizations participating in one of 10 Regional Perinatal Quality Collaboratives (RPQC) to improve maternal and infant health.

Grant recipients include:

  • RPQC Region 1: War Memorial Hospital, Sault Ste. Marie
    • Funding will help provide access to onsite care for infants born with Neonatal Abstinence Syndrome (NAS), which can occur when newborns are exposed to illicit or prescription drugs while in the womb.
  • RPQC Region 2: Munson Medical Center, Traverse City
    • Funding will support the implementation of a screening and intervention tool for perinatal substance use disorder in obstetrics offices and family planning clinics.
  • RPQC Region 4: Kent County Health Department, Grand Rapids
    • Funding will enhance access to local treatment, support and recovery resources through MIRecovery.info for expecting women with substance use disorder in West Michigan.
  • RPQC Region 5: Michigan Health Improvement Alliance, Bay City
    • Funding will support an evidence-based model of group health care, which brings eight to 12 pregnant women together for routine prenatal care.
  • RPQC Region 7: Sparrow Hospital, Lansing
    • Funding will support a mobile health clinic stationed on a rotating basis in the parking lots of three substance use treatment facilities.

Pelletier, the nurse at the RNICU at Sparrow Hospital, has cuddled her share of newborns with neonatal abstinence syndrome in her 15-year career – and done her best to educate their families. As women navigate the foggy days of early motherhood while balancing their own recovery from substance use disorder, it’s difficult to fully educate them, Pelletier said.

“Often times there are moms in the unit, and they can’t be here for the care rounds because they have to leave to get treatment,” Pelletier said. “Or they can only get a ride (to the hospital) one time a day and they have to choose: is that going to see their baby, or going to get their treatment?”

For infants, the signs of withdrawal will subside: at Sparrow, newborns with neonatal abstinence syndrome are discharged typically after a 16-day stay. The long-term prognoses for their health are less defined. They could experience problems with their vision, motor skills and behavioral and cognitive development, as well as difficulty sleeping and ear infections. Close monitoring by pediatricians is recommended to give these children their best chance for a long, healthy life.

As Michigan’s largest health insurer with a strong social mission, Blue Cross has a responsibility to address the opioid epidemic. Blue Cross has dedicated an internal task force to coordinate and advance its efforts, like a program called CLIMB, which stands for Community-based, Life-changing, Individualized Medically-assisted and evidence-Based treatment. The program has already started to show results, including decreasing relapse rates and increasing participation in treatment.

The Blue Cross Blue Shield of Michigan Foundation has consistently funded programs to address perinatal opioid use disorder during the past four years. Most recently, the foundation funded a program in Grand Rapids that offers support to expecting moms by helping them navigate their prenatal appointments alongside medication to treat their opioid use disorder. The program is called GREAT MOMS (Grand Rapids Encompassing Addiction Treatment with Maternal Obstetric Management).

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Photo credit: metinkiyak

 

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