PITTSBURGH – On a chilly Valentine’s Day morning, Beverly Thornton dons gloves and a hospital gown and picks up a baby she’s been soothing for the last few hours. She’s wrapping up her three-hour shift as a “cuddler” in the neonatal intensive care unit at UPMC-Magee-Womens Hospital.
Many of the babies she consoles have been exposed to opiates in utero and are suffering from neonatal abstinence syndrome. As a result, they’re stiff, jittery and irritable. They shake and cry. They’re anxious. They don’t sleep well and have loose stools. Sometimes they rub their arms and legs together or sneeze excessively. They need constant monitoring in the NICU for at least a few days, oftentimes longer.
Some of the infants need medication to help calm them as the opiates leave their system. But the healing power of human touch often means they don’t need as much. And that’s where Thornton comes in, with her soft voice and comforting arms.
“I tell them they’re beautiful,” she said. “I tell them they’re going to be fine. I tell them they have beautiful eyes. Sometimes, you just have a conversation with them in a soothing voice.”
Thornton may see some babies just once and never again. She sees others more frequently and learns what calms them. Some like talking or singing. She recalled one baby who only wanted to hear “The Twelve Days of Christmas.” All the while she’s holding them, she keeps an eye on their vitals through monitors.
Getting them to stop crying is a relief, but sometimes she has to ride through it with them.
“That’s what breaks your heart,” she said. “I don’t like to see them in pain or uncomfortable.”
Magee and other large hospitals in metropolitan areas see the bulk of these children, as smaller hospitals are ill-equipped to handle their care. Neonatal abstinence syndrome affects 7 percent of all births at Magee, which is on par with the national average. Magee started its cuddler program after seeing the instances of NAS rise and the power that human touch has on the babies.
Between 2000 and 2015, the rate of neonatal hospital stays in Pennsylvania related to substance abuse increased 250 percent, according to data collected by the Pennsylvania Health Care Cost Containment Council.
Most cuddler programs are inundated with interested volunteers, because current cuddlers don’t typically quit. However, new programs, like the one at Allegheny Health Network’s Jefferson location, are looking for interested participants.
Patty Genday, executive director of women’s services at Magee, speculated that one reason the program is so popular may be that people feel powerless to help as they watch the opioid crisis decimate their communities.
“This is their way of assisting,” she said. “To watch a baby go through opioid withdrawal, it’s not a comfortable thing.”
Thornton has been retired for almost a decade, and though she has no children of her own, she loves holding the babies because it’s the “definition of being in the moment.”
“Everything is about that baby,” she said. “What can I do right now to help them? What can I do to make them more comfortable? They’re beautiful babies, and they have personalities already. I like the idea of helping them.”
Cuddlers serve as a supplement to parents who can’t be there for a baby’s entire hospital stay. She wishes people understood that whatever led to an infant’s stay, at the end of the day, they’re still just children.
“These are babies. They didn’t ask to come here. They haven’t done anything to create their situation, and they’re going to need help, just like any other baby,” Thornton said.
Not getting pregnant while addicted is the only way to prevent NAS, said Cody Smith, neonatologist at WVU Medicine Children’s hospital. He encourages female addicts to use birth control, especially long-lasting implants, or urges them to make an effort to get clean before becoming pregnant. He said most of these are unintended pregnancies and there’s a lot of stigma for these mothers.
In many cases, a mother is in a treatment program and managing her addition with medication like methadone or Suboxone. That’s much safer than illicit street use, where drugs can contain any number of dangerous additives. Smith said the best thing is to taper use or continue the smallest dose possible to keep symptoms at bay.
When pregnant moms are on Suboxone or other medicated-assistant treatment, their babies are far less likely to need opioid treatment after birth, Genday said.
“Pregnancy is probably not the time to consider taking someone off opioids,” Genday said, because it can add unneeded stress to the mother.
Smith believes there will be some sort of developmental impact for these children, though stops short at comparing NAS to fetal alcohol syndrome, which can cause permanent brain damage and growth problems. He also worries that the babies are at a higher risk for abuse and neglect because they’re fussier. What’s difficult is that there are few services in place to follow up on families after they’re discharged from the hospital.
“It’s probably more the home environment. I think these kids can do well,” he said.
There’s currently not much data on how fetal opiate exposure can affect children later in life. There are ongoing studies looking at potential effects, Smith said.
Babies born with NAS are often called addicted, and Smith emphasized that’s a misunderstanding.
“They’re exposed in the womb, and they go through withdrawal,” Smith said.
Babies do not have any associated seeking behaviors. Addiction comes with a behavioral component, where someone suffering seeks that drug for whatever underlying reason. Once that cord is cut, there’s no more exposure for the infant.
It can be hard to have hope amidst all the negativity surrounding the drug epidemic.
“As a society, we really missed the boat with prescription drugs and the addictiveness of opioids,” Genday said. “We’re on the right track, but we’re nowhere near where we need to be to solve this epidemic.”
Smith said there’s hope in empathy, in being mindful that these are real people going through this.
There is also hope in treatment centers for pregnant mothers. Part of treatment is rebuilding patients’ self-esteem, encouraging them to make good choices for themselves and their family. Many women tell their treatment providers it’s almost impossible to find a doctor that doesn’t look down on them.
Allegheny Health Network offers addiction treatment for pregnant mothers through Perinatal Hope. Most babies born to mothers who complete the program have not needed treatment for NAS, said spokesperson Stephanie Waite.
Magee offers treatment at the Pregnancy Recovery Center’s six locations, which continues treating women even after they give birth. For more information, call 412-641-1211. Perinatal Hope is now available at AHN’s Jefferson Hospital in the South Hills. For more information, call 412-578-5575. Jefferson also has just established a baby cuddler program and is looking for volunteers. Volunteers must be at least 14 years old and will receive training. For more information, call the volunteer services department at 412-469-5885.