At Concord Hospital, Therapies Help Soothe Opioid-Exposed Babies in Withdrawal

Jun 9, 2016

One impact of the addiction epidemic has been a skyrocketing rise in newborns experiencing withdrawal after being exposed to opioids in the womb. 

From 2006 to 2011, the number of newborns in withdrawal more than doubled in New Hampshire, and hospitals say the problem is only getting worse.

  At Concord Hospital, caregivers are working with these families, and trying to ease the transition into life for these little ones.

Barbara Pascoe and Tena Ferenczhalmy at Concord Hospital.

  On a tour of the Family Place, the maternity center at Concord Hospital, center director Barbara Pascoe can’t resist picking up one of the newest arrivals.

“I think what’s so incredible is you think of a year in adult life and you really don’t change much. And then you think of a year in a newborn’s life. It’s phenomenal. Days, hours. It’s just incredible,” Pascoe says.

Pascoe has been working with colleagues here at the hospital on how to make the transition to life easier for babies born with neonatal abstinence syndrome, or NAS.

“One of the things we have for NAS babies is…they look like caterpillars," describing a Woombie. "We pop them in and it helps them self soothe."

'I think what's so incredible is you think of a year in adult life and you really don't change much. And then you think of a year in a newborn's life. It's phenomenal. Days, hours. It's just incredible.'

Last year, 56 infants exposed to opioids were born here; and so far this year, there have been 26.

“Ten years ago, if we had one or two of these children in a year, it was a very big deal for the staff,” Pascoe says.

The withdrawal process that can be traumatic for babies; they cry inconsolably and often can’t sleep.

“To watch a baby go through this is very…it’s painful,"  explains Tena Ferenczhalmy, the hospital’s neonatal nurse educator. "And, trust me, the guilt that these parents’ feel is palpable.”

“We’ve had babies who’ve gone upward of 24 hours with no sleep whatsoever, which we all know is not normal for a baby. A level of irritability. There can be a lot of GI symptoms, as well. So there can be nausea, vomiting, diarrhea.”

As the hospital saw more of these babies, the staff started experimenting with ways to soothe them.

Pam Tyrrell is a certified music practitioner in the hospital’s therapeutic arts department. She performs under the name DeLuna, and plays the harp for NAS babies and their families as part of its music therapy program. For these babies, she starts with something slow and calming.

Credit Data via NH Department of Health and Human Services, MCH, Prenatal Program

“And then if it seems the baby is comfortable with that, I may pick it up to more of a heart rate rhythm because babies’ hearts are so fast, so I may pick it up," she says. 

“A lot of the things that I hear from the nurses and the mother is my baby just had a full feeding. It’s the first time my baby has actually gone through that. And that’s huge. That to me shows there’s a great comfort there.”

And babies may hear something different, like a Native American flute played by Amy Sarasvati, another certified music practitioner at the hospital.

“We are watching their breathing. We are watching their reaction. We are tailoring our service really to what’s happening for them," says Sarasvati. "There’s a big difference between performance and therapeutic music.”

The hospital has also been offering Reiki and aromatherapy, delivered through oils with scents like peppermint and ginger soaked into cotton balls; babies, they tell me, are particularly fond of lavender.

Video: Concord Hospital's holistic approach to treating babies with neonatal abstinence syndrome 

Hope on the Front Lines: Concord Hospital from New Hampshire Public Radio on Vimeo.

Alice Kinsler, the hospital’s therapeutic arts director, says they’re able to actually see how music and scents help.

“If the baby is being monitored on a heart monitor or their vital signs are being monitored, we can see if their heart rate goes down. The musicians understand how to use their music to bring a heart rate down noticeably and we can see that on the monitor.”

Still, these soothing techniques are only complementary to the babies’ medical needs.

“We treat them with morphine, and they can wean off in a period of eight days, ten days, and go home like a normal newborn.”

Barbara Pascoe, the Family Place director, says it’s during this critical time when nurses offer support and guidance to mothers, some of whom are still using illicit drugs.

“We have this very little window of time where if a mother is going to make a change in her behavior, she’s going to do it when she has a baby because there’s a new little person that’s depending entirely on her.”

Many of the mothers go into treatment prior to birth, but maintenance drugs like methadone can still lead to NAS.

'All of us have probably made decisions in our past. But whenever you realize that you made a bad decision and you've actively on a path to do the right thing, then let's support that instead of continuing to keep it in the shadows and make it something dirty.'

In the best-case scenarios, Tena Ferenczhalmy says, the hospital’s treatment begins prior to birth with pre-admission meetings.

“A lot of these families are fearful that we’re going to remove their baby from them as soon as it’s born, and we’re actually modeling and mimicking the exact opposite. We know that babies, during withdrawal, have the best outcomes whenever they have a high level of interaction with their biologic parent.”

And developmentally, outcomes for NAS babies are positive, though they’re all referred for early intervention services as a precaution.

Ferenczhalmy says babies treated with morphine aren’t at a higher risk for drug abuse later in the life, something parents are often worried about. But mostly, she says the hospital works to get rid of the stigma for these families.

“All of us have probably made decisions in our past. But whenever you realize that you made a bad decision and you’ve actively on a path to do the right thing, then let’s support that instead of continuing to keep it in the shadows and make it something dirty.”

Pam Tyrrell is a certified music practitioner at Concord Hospital. She performs for babies going through withdrawal after being exposed to opioids in the womb.

  Of course, it’s not always easy.

Back at the Family Place, I talk with Pascoe about how complicated many of these family situations can be.

“I think the most challenging situation for us would be one where the mother has an issue and she hasn’t shared it with her family or her partner. And then we get a lot of questions about why is the baby still here and because of patient confidentiality, we can’t share that. And I think that the mothers are really selling themselves short in terms of the support of they would have available to them.”

"Have you seen circumstances where there is multiple members of a family in addiction?"

"Absolutely. And I think that’s what makes it really important that we treat these patients and give them the skills they need because when they go back out into the community, they may be going back out into a situation that isn’t conducive to the kind of care that we’re providing or their ultimate goals.”

And that’s why the hospital keeps the care going for the mothers after they’re discharged, offering lactation courses and a post-partum emotional support program.