Overcoming Drug Addiction for Pregnant Women and Parents

On learning last year that she was pregnant with her second child, Cailyn Morreale was overcome with fear and trepidation.  “I was so scared,” said Morreale, a resident of western North Carolina. In that moment, her joy about being pregnant was eclipsed by fear that she would have to stop taking buprenorphine, a drug used to treat opioid withdrawal that had helped counter her addiction. For decades, most doctors have relied on medication-heavy regimens to treat babies experiencing neonatal opioid withdrawal syndrome. Those protocols often meant separating newborns from their mothers, placing them in neonatal intensive care units, and giving them medications to treat their withdrawal.  But research has since indicated that in many, if not most, cases, those extreme measures are unnecessary.  A newer, simpler approach that prioritizes keeping babies with their families called Eat, Sleep, Console (ESC) is being increasingly embraced.  Cailyn's experience was different because she had found her way to Project CARA, an Asheville, North Carolina-based program, that supports pregnant women and parents with substance use disorders. Her care team assured her she did not need to discontinue buprenorphine and that her baby would be assessed and monitored using the ESC approach. The protocol deems babies OK to be sent home so long as they’re eating, sleeping and consolable when upset.  In recent years, doctors and researchers have found that keeping babies with their mothers and ensuring they’re comfortable often works better and gets them out of the hospital faster.  Cailyn was never separated from her son.  She was able to begin breastfeeding immediately.  In fact, she was told, the trace of buprenorphine in her breast milk would help her son withdraw from it.  Sarah Peiffer is a Project CARA practitioner and family health physician and a vocal proponent of ESC and its approach to partnering with families. “You look at all the nonpharmacologic stuff you’re supposed to be doing — like keeping the lights low in the room, keeping the baby swaddled, doing as much skin-to-skin with mom as possible — and you really treat mom as medicine.”  Matthew Grossman, an associate professor of pediatrics at the Yale School of Medicine, helped to pioneer ESC.  The objective was to place the family at the core of care — shorter hospital stays for babies was simply a fortuitous outcome. The approach fits into a wider move toward judgment-free, family-centered care for those who’ve experienced addiction and for their children.  Here's the link: digitaledition.baltimoresun.com/infinity/article_share.aspx?guid=40492f49-6d79-4432-ac1d-45ea5889caab