Thursday, January 24, 2013

Taking Care of Babies that are Addicted

Today I wanted to talk about something troublesome I deal with at work. (For those of you that are new, I have worked the past 2 years as a Neonatal Intensive Care Unit nurse.) And I hope I don't come off as not compassionate or judgmental. Because I love my jobs and the babies I am blessed to take care of. But it's something that's been on my mind lately. And I wanted to give you all a little insight into a difficult aspect of my job. Forewarning, it may be difficult to read, and remember, these are my own opinions. 

Most people thing that in the NICU all we have are teeny tiny really sick babies. However, sometimes we get seemingly healthy babies. Until you get a little deeper on why they are here. Sometimes, we get a baby who is addicted to a drug or medication at birth. The mom took a certain medication or drug during her pregnancy that creates a dependency in her baby. Once the baby is born, they are cut off from their "supply" essentially. The babies then go through a process of withdrawal. The baby is actually experiencing physical pain. Some people wonder, how do you know a baby is withdrawing? Well, we have certain signs and symptoms we look for.

Firstly, with most babies, we run a drug test. If we can catch the first or second urine the baby has, we can test it. It will tell us anything the mother took within a few days of giving birth. The meconium is the the first stool the baby has. It tells everything the mother took during majority of the pregnancy. This one is the one we see positive the most. The one symptom that sticks out the most to me is their cry. It's hard to describe the cry of a severely addicted baby. It's so high-pitched and shrill that it shoots straight through you. And they are inconsolable. There's not much you can do for them. We do whatever comfort measures we can. We offer the pacifier. And they will excessively suck on it. We swaddle them tightly. This helps with their own tightness. These babies are so rigid. I've seen one where I could push on her legs and her upper body would sit up. They also tremor. I'll never forget this one who was shaking so bad. He never cried, which made my heart hurt even more. I simply picked him up and held him to me as tight as I could to help control some of his shaking. Although I have never seen it, they can even have a seizure. Their metabolism is so high they often run a temperature and sweat. They have severe diarrhea which usually will break down their behinds to the point that they bleed. They will sneeze constantly, have trouble eating, projectile vomit.

The babies are treated, depending on their severity, with medication. Some hospitals use morphine, some use methadone. Which are addictive medications themselves. And the babies have to be slowly weaned off of the medication to ease their pain and help with the withdrawal process.

It's really difficult to watch these babies go through it. And, to be honest, it's very trying on us as a nurse to care for these babies. Your heart breaks for them. They cry all the time but there's nothing you can do. You simply have to let them cry it out. We hold them when we can. You'll see us passing the baby from nurse to nurse in an attempt to console them. We put them in swings, bouncers, whatever we can find in an attempt to soothe them. Mentally, you can't take care of a severe addicted baby for more than a day or so. It is stressful and emotionally draining.

This documentary from NBC News is very good. It's 12 minutes long but well worth the watch. It accurately shows what a baby that is withdrawing looks like and how they are cared for.

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Some moms have no choice and are on certain medications that cause the baby to withdraw. Then there are moms who intentionally take drugs or prescription pills.  And what I struggle with is having sympathy for these mothers, especially the ones who do drugs, especially the "repeat offenders". They'll be crying saying "I didn't know this would do this to my baby." And I just have to politely smile and nod while inside, I'm thinking "Really? This is your 4th kid up here for withdrawals. You knew exactly what was going to happen every time you popped those pills or shot up." There are the ones that cry and say "this is all my fault." I don't coddle them and say "awww, honey, it's not your fault". Because it is their fault. I tell them that what happened is done, and now we have to focus on getting their baby better. I refuse to tell them that it isn't their fault. I just don't feel sorry for them. I feel sorry for the baby. It's not the baby's fault. 

And I was recently talking to someone and they asked me if these mothers are arrested for child abuse. Because, essentially, these mothers are giving drugs to their child. And the cold hard truth is that in today's society, the unborn baby is considered an "extension of the mother's body". Don't get me wrong, these mothers do have to go through some social stuff. They are flagged as a "social services case". The Department of Children and Family Services opens up an investigation. They go out to the home, do inspections, talk with the mother and family. Then, they decide if they are going to send the baby home with the mom. If they do, the mom will have random visits, random drug tests, and basically have to keep their act together. Sometimes, they remove custody and the baby goes home with a foster family until the mother straightens up or the baby may end up in the system for their entire life. I always tell moms, when they find out we know their baby is addicted, to be honest. Tell them everything you did and took. Because we know based off of the drug test. Don't lie and say you didn't take it. We have the proof. And the more honest you are, the more likely you'll be able to keep your baby.

It seems that lately, doing drugs/pills during pregnancy is the new thing. Within the past year, the number of babies that we get due to withdrawals is through the roof. We used to get 1 every now and then. The other day, 1/3 of our unit population were drug addicted babies. And these are only the ones severe enough to be transferred to the NICU. It's not counting the ones who may show slight symptoms and who have a positive drug test, but don't need to come up to the NICU. 

I just don't understand how someone can do this to their own child. It blows my mind. And I feel like a terrible person for judging these women. I don't know their situation. I don't know what led them to do drugs. The moms addicted to prescription pills blame their doctor. "Well, he gave me the prescription." While I do believe that medications are often overprescribed, the patient is the one who makes the decision to take the medications. It's like the whole gun controversy. Guns don't have a mind of their own. Guns don't shoot people. People shoot people. And although I have taken medications that I could see how they could become addictive, I had to make a conscious decision that no, I don't need this med anymore. And I stopped taking it. And there's a whole other controversy over addiction being hereditary and genetic that I don't have time to get into. The basic point, is that I really struggle to have sympathy for these mothers. And it's something I'm trying to work on. To show more compassion to these mothers.

So I hope I haven't offended anyone! I just wanted to give an honest look into what it's like caring for the drug addicted baby.


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