By Cecilia Chan, GSN Managing Editor
Monique French was taking prescribed psychotropic medication and Subutex to treat an opioid addiction when she became pregnant in November 2017.
She had been on prescription opioids since 14 to treat chronic pain from endometriosis but ended up abusing her medication, at one point using heroin. She was switched to Subutex for pain management.
French said she had a normal pregnancy and there were no red flags – until her son, Malachi, was born on Aug. 4.
“My son was in the hospital for two months,” the 33-year-old Mesa mom said. “He has neonatal abstinence syndrome.”
Gilbert-based nonprofit Hushabye Nursery was founded to serve moms like French, but it also wants to help babies like Malachi.
The need has never been greater.
Neonatal abstinence syndrome – commonly called NAS – is the name for a baby’s withdrawal symptoms from drug exposure in the womb before birth. Most babies who withdraw show signs within 24 to 72 hours after birth, though some symptoms may not appear for seven to eight days, according to experts.
Malachi was one of 1,472 NAS babies born in Arizona from 2008-13, according to the state Department of Health Services. NAS rates have increased 235 percent in Arizona from 2008-14, the department reported.
A Centers for Disease Control and Prevention study of 28 states found that babies born with an opioid dependency tripled in the 15 years ending in 2013.
On average over 14 babies a week are born in Arizona with possible drug-related withdrawal symptoms, according to Hushabye Nursery, which has been holding support groups at various locations in the Valley since 2017.
A pregnant woman using opioids who reaches out to Hushabye gets counseling on what to do and is connected to obstetrician and treatment programs.
The nonprofit is looking for donated space for a NAS residential facility that will keep moms and their babies together and support their recovery.
It would be the first in Arizona.
“Our goal will be to house 12 moms and their babies,” said Gilbert resident Tara Sundem, who co-founded Hushabye with Ahwatukee resident Kelly Woody, both neonatal nurse practitioners.
The nonprofit envisions starting off with 12 private rooms, each big enough to have a twin bed, a crib and a rocking chair.
Neonatal withdrawal can take up to eight weeks. Once the babies are stabilized in the hospital, they would be transferred to Hushabye Nursery to continue their withdrawal journey.
Unlike a neonatal intensive care unit – which is high-paced and noisy – Hushabye’s nursery would provide the quiet, calm environment NAS babies need to recover, according to its founders.
“Sometimes it can take a couple of months to recover, it just depends on the baby,” Sundem said. “Most literature say up to six months but in talking to many moms, it’s about a year.”
What a baby goes through during withdrawal is similar to that of an adult’s, according to Sundem.
“I had one mom describe withdrawal as the worst flu and migraine times 100,” she said.
Signs of withdrawal in a baby include seizures, high-pitch crying, sneezing, vomiting and sweating. Babies having a difficult time are given morphine and are then slowly weaned off of it, according to Sundem.
“We have specially trained staff that wants to work with this population,” she said. “You really have to have dedicated caregivers for this special population.”
Sundem said Hushabye want to replicate Lily’s Place in West Virginia, the country’s first neonatal abstinence syndrome center when it opened in 2014.
But unlike Lily’s Place, which only treats babies, Hushabye would treat both the baby and the mom or primary caregiver, Sundem said.
“The mom or primary caregiver can stay 24/7 and while they do that they will get intensive outpatient therapy and stay and learn to care for their babies,” she said. “We also treat their opioid-use disorder. We are giving these families hope. Babies are supposed to be fun and exciting and you find these moms hopeless.
“You give them support and treat them like we want to be treated. We are making it so they are healthy enough and that it is safe to keep families united.”
In Arizona, reports of substance-exposed newborns are increasing, according to Darren DaRonco, spokesman for Arizona Department of Child Services.
In fiscal year 2016, the department received approximately 3,700 reports; in 2017, 4,200 reports; and in 2018, about 4,300 reports, DaRonco said.
“The department does not automatically remove children due to substance exposure in utero and we do not remove children solely based on a parent’s substance abuse,” he said. “A removal is based on each family’s unique circumstances and whether the individual can safely parent the children.”
He said the goal is to to mitigate the safety concerns so children and families can remain together.
French said Hushabye’s proposed facility would have been a big help for her.
The hospital discharged Malachi from NICU after he was weaned off morphine and sent him home with French, who was clueless on how to care for her baby.
“I’m a first-time mom without support,” she said. “I didn’t understand why he was crying, why I couldn’t hold him and why he wasn’t sleeping. I didn’t know what was wrong.”
She also didn’t know a NAS baby could exhibit withdrawal symptoms for six months to a year.
She purchased a number of sleep-aid items such as a swaddle blanket in an effort to soothe her inconsolable baby. But after two weeks of literally not sleeping herself, she sought help at the Child Crisis Center.
A center nurse put French in touch with Sundem, who provided support such as teaching her how to console Malachi.
“With a NAS baby you have to shush and rock them differently,” French said. “Normally with a baby, you rock it back and forth. With him, it was up and down in a rapid motion. And when you shush a (NAS) baby, you slowly have to shush. Little things like that made a huge difference. I can put him down and he is fine. Before Tara, he would be screaming bloody murder.”
At 7 months, Malachi is now starting to attend Tutor Time. Sundem had gone in beforehand to explain to the staff on how to comfort a NAS baby, French said.
Her son also has access to health-care providers such as occupational and physical therapists.
Hushabye’s mission calls for offering non-judgmental support, education and counseling to mothers and families, something French said she wished she had.
“It’s been really hard,” French said. “I wasn’t one of those moms on drugs and being in the hospital with my son going through withdrawal, everyone from the nurses to the doctors was horrible to me – ‘How could you have your son like this?’”
French said because she was on prescription Subutex, she thought she was fine when she found out she was pregnant.
According to a 2016 study, the increase in use of prescribed opioids among women during pregnancy has probably contributed to the rise in NAS.
In the US, estimates suggest that 14-22 percent of pregnant women obtain an opioid prescription during pregnancy, and there has been an increase in opioid-use disorders among pregnant women, according to the study.
Even if French could have gone through detox, she would have been advised against it. If a mom has been using and she finds she is pregnant and stops, she’s at high risk for relapse, Sundem said.
“If you could go through cold turkey and not miscarry, the likelihood of people being successful is very low,” she said. “The next time they use, they are at a very risk at overdosing and losing the baby.”
Sundem said Hushabye is open to offers of space anywhere in the Valley.
“The opioid crisis is everywhere, so we are open to any location,” she said. “What we expect is wherever we start that once we are able to have proof of concept that we are able to say this works, we are able to spread out and go to different parts of the Valley.”
While waiting for someone to donate the use of a building, Hushabye has been building community partners.
“By doing that, more and more people are realizing the impact we are having with the families,” she said. “We have a lot of community partners that reach to us and want to work with us but not anyone who says, ‘here is a building.’”