Changing attitudes, parents, help addicted babies thrive
SANDY QUADROS BOWLES
Jun. 27, 2016
NEW BEDFORD, Mass. (AP) — Eight-day-old Braylin Debonise dozes in her crib, barely a week into the world and blissfully unaware.
She doesn't realize that she is spending the first few weeks of her life being treated for the opioids she was exposed to at birth.
She doesn't yet understand that her mother's history of addiction led to her needing special care and treatment in the first days, months and years of her life.
She doesn't recognize the determination of her mother to live a clean life, with the support of her father, also a recovering addict.
But she will learn all of this in time. Her mother, Amanda Fielding, has no plans to hide the truth from her and her sister, Briella, 20 months old.
Briella was also born addicted to methadone.
"I don't want to hide anything from them," she said. "I'm not going to sugarcoat it. I'd rather be honest with them. As they get older, I don't have a problem talking to them about it."
Fielding was abusing prescription pills by 13.
By 24, she was an IV heroin user.
She "died" four times, revived by doses of Narcan, a drug given to counteract the effects of an overdose.
Her days passed in a destructive, droning pattern. She woke up sick and with one thought racing through her mind: Need more heroin.
To fund her habit, she stole jewelry and "anything and everything" from people, including her parents.
She would mix heroin and benzodiazepine medications, often called "benzos" for short, which are widely prescribed for the treatment of anxiety disorders and insomnia. That, she said, was "a very dangerous thing to do."
Under the influence of the combination of substances, she crashed her car into a stump of trees.
"I fought it for a long time," she said. "I was sick and tired of being sick and tired."
On March 1, 2013, Fielding entered a methadone clinic and celebrated her first day of sobriety. "Pretty much I've been clean since then," she said. "The clinic saved my life."
Treatment, she stressed, involved more than a visit to the clinic in the morning, getting a dose of methadone and leaving.
She participated in group and one-on-one therapy. "It's a whole different lifestyle," she said. "You really have to want it."
And while she was in treatment, fighting for her sobriety, she became pregnant.
At one time, women who gave birth to babies exposed to narcotics were treated with scorn and shame, experts said.
That attitude does little to help either the mother or the baby, according to those who work closely with them.
"This mother has an illness; she has an addiction," said Dr. Brian Sard, chairman of pediatrics for Southcoast Health. "We work with them as opposed to working against them."
The earlier a drug-addicted woman reaches out in her pregnancy, the more likely she and the baby are to have a positive outcome, experts said.
Close medical supervision can help ensure the mother does not withdraw from the drug cold turkey or overdose, Sard said.
For heroin users, "every effort is made to get them on methadone" to maintain a stable pregnancy, said Dr. Jessica Slusarski, site leader for the St. Luke's Hospital Special Care Nursery.
Expectant mothers can then be placed on a "maintenance program" that can range from making every effort to stop smoking marijuana, for example, to ensuring the mother-to-be remains in methadone treatment as she withdraws from heroin.
And the women receive more frequent monitoring to ensure the fetus is growing at a healthy rate. Opioid-exposed babies can be vulnerable to "poor growth to the fetus," said Dr. Slusarski. But in most cases, she said, the fetus reaches full-term and is well-developed.
This kind of positive treatment is far more likely to result in a healthy baby and far less likely if a woman feels she would be shamed for her situation, experts said.
Once the baby is born, a medical team works closely with the mother and the infant.
Both are visited by medical staff every three hours to take their vital signs such as blood pressure and temperature. This helps them monitor for signs of withdrawal.
Medical personnel use a monitoring system known as the Finnegan scoring system to determine the best therapy and treatment for opioid-exposed babies.
The system looks at a series of issues, including: Did the baby spit up? Does she wake up crying and difficult to control? How is she eating and pooping?
All of this work is done "as inclusive of the parents as possible," said Dr. Slusarski. "We promote the parents' comfort and readiness."
Nurses are trained on how to evaluate these symptoms. An infant may naturally exhibit one or two of these signs, Dr. Slusarski said, but when "when things start adding up" the baby may need medication to help withdrawal.
The goal is "not to sedate the baby, it's to manage the withdrawal," she said.
In addition to the medical intervention, "a team effort" goes into place, she said, that often includes social workers and lactation specialists.
An occupational therapist also comes in and works with the baby, perhaps offering infant massage and teaching parents to do the same, said Sard.
"We see lots of mothers being more proactive," said Lisa Tibbetts, registered nurse and director of the family centered unit at St. Luke's Hospital.
The approach "has moved away from, I'm doing something in secret," she said.
Heroin might be the drug publicly associated with babies born exposed to opioids, but medical experts locally are seeing a new trend: Mothers addicted to several substances at once. In many cases, they are addicted to pharmaceuticals.
Dealing with babies born to mothers with this addiction, known as polypharmacy, "is more complex," Dr. Sard said.
Dr. Leslie Kerzner, director of newborn follow-up program and staff neonatologist at Massachusetts General Hospital in Boston, agrees. And she places some of the responsibility for the growing number of cases on the medical establishment's increased reliance on pain medication.
"Pain became the fifth vital sign," she said.
To eliminate pain, doctors would prescribe pain medication and some patients would keep extra pills on hand, which could then find their way to others in the household, she said.
Now, she said, "we have all these addicts to deal with." As a result, she said, "we're not going to see a decrease soon" in prescription pill abuse and with it, pregnancies in women struggling with these substances.
The future of babies born exposed is not easy to determine, experts said.
"The jury is still out on that," said Dr. Sard. "We're still learning."
"Across the board, the baby's outcome is very difficult to study and to compare one case to another" Dr. Slusarski.
Dr. Kerzner is studying the issue. She is working to determine the progress of these babies past their second birthdays.
Her study follows high-risk babies, which can also include babies born prematurely.
She examines their fine and gross motor skills and their cognitive and neurological abilities. Visual impairment also has been reported in babies born addicted to heroin.
Although much remains uncertain, one factor is critical to ensuring the best possible outcome, she said: The health and involvement of mothers.
This can be problematic if the mother remains untreated for her illness.
During the first three months after birth, new mothers have a "high relapse" likelihood, she said.
Chronic opioid use can cause mothers to "miss the cues" that indicate a baby's needs, she said.
"A mother might think, 'I'm not hungry, so he's not hungry,'" she said, citing a hypothetical example.
"Tell me, how is a baby going to learn to walk if he's in his seat 12 hours a day, sitting in his urine and feces?" she said.
"I see some very sad cases," she said.
Mothers with a strong support system have a better chance of success, experts said. Family members can step in temporarily to help, maybe caring for the baby short term while the mother recovers.
In other cases, the baby might end up in foster care.
"Every mother has love for their baby and wants to do what's right, but it's harder for women who are still using," Dr. Slusarski said. "They can have difficulty controlling their impulses and not be as present or involved."
But many patients, such as Fielding and her daughter, experience more positive outcomes.
Braylin is home now and will continue to receive phenobarbital at home with the goal of recovery in two to four weeks, Dr. Slusarski said.
"There is no reason to believe that she will experience any serious long-term" impacts from her exposure to drugs, Dr. Slusarski said.
Brielle, Braylin's sister, shows no signs of developmental delays or other serious issues, Dr. Slusarski said, which is a good sign for Braylin's outcome. Brielle scooted around her sister's hospital room, coloring with her dad and screeching happily for a visitor. "She seems to be developmentally fine."
Her family "seems to be very attentive and responsive to her needs," Dr. Slusarski said. "They're very present throughout" the girls' days.
Amanda is "very invested in their child" and she and the girls' father, Anthony Debonise, are dedicated to "getting themselves healthy," Dr. Slusarski said.
Debonise said his and Fielding's history with addiction will make them more aware of any potential vulnerabilities that their daughters might face.
"Just because we're in recovery and used to be heroin addicts doesn't mean we can't raise a healthy baby and be a family," he said. "It's really reassuring to know that doctors are here specifically for that purpose. You want your child to be healthy and to get the best medical care they can."
"These little girls depend on us," Fielding said. "We have to make sure they have everything they need. I'll do anything I can to make that happen."
Information from: The (New Bedford, Mass.) Standard-Times, http://www.southcoasttoday.com