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I work in a neonatal intensive care unit where we frequently care for babies that are born dependent on drugs that they have been exposed to during pregnancy -typically maternal methadone or buprenorphine although it can also be illicit drugs.  (Please note that I said dependent on – babies are NOT born addicted.)  As you can imagine friction can often develop between the families of these babies and the health care providers caring for them.  Mothers have received mixed messages for years about what to expect when their baby is born.  Some are told that they won’t withdraw and/or they will not need to stay in the hospital.   These same parents have been very surprised when their baby gets whisked away for treatment with morphine or when he/she has to stay in the hospital for observation after they themselves have been discharged.  This often results in anger and resentment.  We’ve been on a journey to educate area health care professionals about the management of these newborns to try to stop the spread of inaccurate information to parents.  We have also been interacting more proactively with some of the parents and it is those interactions that led me to write this.

First I think it’s important to mention that one of our nursing leaders developed the relationship with the local methadone clinic when she was working on a school assignment.  After working as an RN for years, she was enrolled in classes online to complete her BSN.  This is a great example of how expanding one person’s knowledge can actually have a ripple effect and change an entire department, community, etc.  Martha is one of those folks who never meets a stranger.  She always has a smile and often a hug or a pat on the back for whomever she is speaking with.  This made her the perfect ambassador to start out at the methadone clinic and I am sure why this ripple turned into a pretty significant wave. 

As many of us in the unit began to recognize and discuss the disconnect with families we started to think that letting them know what to expect, preparing them for potential admission, as well as letting them see that we have the best interest of their baby in mind would make circumstances better on both sides of the crib.  Others started to join Martha at the methadone clinic for the women’s group session.  I was there for the inaugural session where we went as with the multidisciplinary group.  We took food and chatted with women over the break.  Not all of them were pregnant or even of child bearing age, but they still listened with interest.  Some had questions about friends or relatives who were actively using drugs and pregnant.  Eventually over time we have been dubbed “the baby ladies.”  There is sometimes a list of questions for the baby ladies or women from outside the group that will come over for the morning that we are there.

I am not able to attend every session at the methadone clinic, but someone from the NICU is usually there once each month.  I always try to send students or residents that I have on rotation with me because I think this is an experience like no other.  There are often very colorful and frank discussions at these meetings that shock and even entertain us, but at the end of the day I think this experience gives everyone some insight into this population.

Things that I learned at the methadone clinic:

I was surprised that several of these women seemed a lot like me.  They were around my age.  They were mothers.  If I met them under different circumstances we may have become friends.  It definitely dispelled the stereotype “druggie” getting high on a street corner.

Women in recovery- on methadone or buprenorphine- have not traded one addiction for another.  They are battling a disease.  One that ACOG recognizes as a chronic condition just like hypertension or diabetes.  Patients aren’t shunned or ostracized for receiving medical treatment for those conditions and addiction should be no different.

Women on methadone/buprenorphine can be good mothers.

Women in recovery are afraid of disclosing this information to health care providers.  They anticipate that they will be treated differently, looked down on, and belittled.  I’ve heard stories of women who have been denied pain relief because of their history although they were obviously hurt or in one case had surgery!  They don’t trust us because they assume that we don’t trust them.

On a lighter note, I commute into the town where I work and for a long time did not know my way around some parts unless they are in the general vicinity of the hospital.  Whenever someone talked about going somewhere downtown I would always ask if it was near the methadone clinic- it was my point of reference.  I can’t believe the residents have never roasted me on this! 

One of my residents recently shared her experience of attending methadone clinic during my rotation at a PGY2 interview.  The interviewer, who like me works with babies going through withdrawal, said she thought it would be difficult to not be angry with these mothers after seeing the way the babies in withdrawal suffer.  These babies can have significant symptoms.  I in no way intend to make light of that.  I am only human after all and sometimes slip into the old mindset of anger and judgement still myself.  I have learned however that trying to understand and having compassion for the mother can affect the bonding between mother and infant.  This can improve care for the baby when mom feels free to spend time with her baby and doesn’t feel judged or uncomfortable coming to the unit. 

I am interested in thoughts of those of you who may take the time to read this- I hope that I will hear from you.