HAMILTON—In a darkened, quiet room off the third-floor neonatal intensive care unit at St. Joseph’s Hospital, Christie cradles her baby Sam. He is swaddled tightly in a white hospital blanket, with a matching white cap on his chubby bald head. Nurses shuffle back and forth outside the door as muffled cries echo through the hallway.
Christie is nervous. In just a few hours, she will meet Sam’s future foster mother — the woman who will take her baby home from the hospital in just a few days. Sam was born with Neonatal Abstinence Syndrome (NAS), meaning that he came into the world in opioid withdrawal.
For this first 31 days of his life, he has lived at the hospital, as his tiny body is slowly weaned off the morphine he is given to combat the shaking and shivering and fever and near constant crying that can come with NAS.
Baby Sam is one of an increasing number of babies in Canada born with an opioid addiction. In the St. Joe’s NICU on this day, there are five babies being treated for opioid withdrawal.
“When I started (20 years ago), we’d maybe have one every six months,” says registered nurse Ann Patton.
NAS rates are up nationally, provincially, and even locally in Hamilton — a byproduct of a deadly opioid crisis that is killing thousands of people across the country each year.
For every 1,000 babies born in the province between April 2015 and March 2016, 5.9 were diagnosed with NAS. The national rate was 4.2 births per 1,000. Those figures are a stark increase from a decade earlier, when the provincial and national NAS birth rates were both 1.8 per 1,000.
In Hamilton, there were roughly 45 NAS births in 2015 — a number that shot up to roughly 62 last year.
For those struggling with addictions, pregnancy can be a difficult experience; one wrought with shame and fear and guilt. These women know drugs are bad for their unborn children. But quitting is easier said than done — and in many cases, going cold turkey during a pregnancy can be much more dangerous. But doctors say that a pregnancy can also offer a unique and unprecedented chance to engage.
In the face of this epidemic, the Spectator explored the local programs that support moms with addictions and babies with NAS. This three-part series shares stories of heartbreak and perseverance from those at the very heart of this fight.
Christie and her boyfriend, Sam Sr., both 27, have long struggled with opioid addiction.
These are not their real names. Because their baby is going into foster care, legislation protects the family from being identified in any way.
For Christie, it was during her pregnancy — which she discovered only between the fifth and sixth months — that she felt ready to get help. She’s now on methadone and in a residential treatment program, which linked her up with the Maternity Centre before baby Sam arrived — a program she is grateful for.
The Centre, which runs out of the David Braley Health Sciences Centre in the downtown, has a specific Program for Substance Use in Pregnancy (PROSPR).
“We had started to see (moms with these issues) at the Maternity Centre . . . and we really didn’t have a co-ordinated approach to their care,” said Dr. Elizabeth Shaw, the program’s founding physician. Inspired by the work that was being done at Toronto’s TCUP (Toronto Centre for Substance Abuse in Pregnancy) program, Shaw knew there was a similar need here.
PROSPR provides “one-stop shopping” for expectant mothers with substance use issues, offering both neonatal (or antenatal) care and methadone out of one clinic. By combining medical and addiction treatment into a single appointment, Shaw and Dr. Jill Wiwcharuk say they increase the likelihood of their patients actually making them.
“As soon as you put those together, you’ve decreased the amount of appointments in their life by a ton,” says Wiwcharuk, who is also the executive director of the Shelter Health Network.
“Our women’s lives are so chaotic with so many competing priorities that they find it difficult to show up to all the appointments necessary for prenatal care. But they rarely miss an appointment for methadone. So it can really help get patients the prenatal care they need.”
In the three years since it has launched, roughly 60 women have gone through the PROSPR program. The three-person team — Shaw and Wiwcharuk, along with nurse practitioner Claudia Steffler — also works closely with the NAS clinic at St. Joseph’s, where that support is carried through delivery and into infancy.
Their program is not restricted to women using opioids. Some of their patients also struggle with alcohol use or other drugs such as cocaine.
Signs of withdrawal in babies can occur within hours of birth, or can take days to appear.
For Christie and Sam, having been through withdrawal themselves made it harder to watch their little boy go through it.
“We both know what it’s like to go through withdrawal, it was hard to see a newborn going through that,” dad says.
A scoring system called ‘the Finnegan Score’ is used to monitor the baby’s symptoms — things like tremors, broken or red skin, excessive crying, sweating, sneezing, vomiting — and determine whether medication (like morphine) is needed. If it is, the baby’s hospital stay can be extended from five days to several weeks.
During that time, parents can stay in bunk rooms (called “care by parent” rooms) outside the NICU, which allows them to be nearby for feeding or holding duties. While babies in withdrawal do not necessarily need high-tech care, they require lots of hands-on care — literally near constant holding.
Moms who are on methadone can also breastfeed. It’s encouraged. Such little amounts of drugs pass through breast milk that the benefits generally outweigh any worries about continued drug use, the doctors say.
Though she was able to, Christie opted not to breastfeed baby Sam. Knowing he’d be going into foster care, she didn’t want to forge a bond that would be broken so quickly.
The hardest part for her, she says, was the uncertainty during her pregnancy — not knowing what to expect, or whether her baby would come out OK.
“I was worried,” dad says, nodding. “I didn’t want him coming out with two heads.”
In reality, NAS is not a life sentence. With the right care, many babies born in opioid withdrawal go on to have perfectly healthy childhoods and perfectly normal lives.
But it is this fear, and the stigma around drug use, that keeps so many expectant women with addictions from getting the prenatal care they need. A hospital can be an intimidating and scary place for these women. They feel judged by the staff, and even the other patients — and so, often times, they stay away.
“It’s always sad when somebody comes in and we’ve never met them before and they’ve had no care. It happens not infrequently,” says St. Joseph’s Healthcare pediatrician Dr. Sandi Seigel, another member of the support network.
“It is heart-wrenching,” Seigel acknowledges. “But the reality is it’s not going away.”
“If you’re on a stable methadone dose, then that’s the best scenario if you have an addiction. The best thing would be if you can fight your addiction before you get pregnant, but we don’t see a lot of it . . . and it’s true that a lot of these are unplanned pregnancies,” Seigel says.
Getting onto methadone is a major step in a mom’s recovery — one to be celebrated, not criticized, they say — and one that could mean the difference between her ability to parent her baby and the baby being taken from her.
According to a 2014 audit by St. Joseph’s Hospital, Seigel says close to 60 per cent of their NAS babies went home with their mother upon discharge. Another 10 per cent went into “kinship care” (with a relative or friend), and roughly 30 per cent went into foster care.
“More than half do go home with their biological parent, even if CAS is involved,” Seigel says.
Most of these moms do want to parent, they say — whatever that arrangement looks like. It is rare that they have a patient who wants to put their baby up for adoption.
Abortion, of course, is the third option. But the reality is that many of these women, particularly those who come through the shelter health network and whose lives are more chaotic, are coming in for care too far into the pregnancy for abortion to be an option.
Opioid use can affect a woman’s menstrual cycle to the point that she may rarely have her period, and therefore may not realize she is pregnant.
Dr. Suzanne Turner, a family physician at St. Michael’s Hospital in Toronto who has studied NAS, says that it is important to connect with women with addictions to discuss the possibility of pregnancy with them.
“We can do a better job of saying to them: if you don’t want to get pregnant during this time, you should be on birth control — and if you do want to be (pregnant), there are some things we can offer you to make this pregnancy as safe as possible,” Turner says.
Often these women have had a lifetime of trauma — another reason for the fear of authorities and institutions including hospitals. Maybe they grew up in care themselves, or have dealt with the justice system, they say.
For Christie and Sam, it was indeed their baby that sparked the desire to finally get clean. Christie is now in a residential treatment facility. Sam has been on methadone for a full month, off street drugs since the day his son was born.
“I can celebrate my recovery anniversary every year on his birthday,” he says, grinning.
For today, Christie is ready to meet the foster mom, but she is not ready to see her interact with her baby. She doesn’t want to be there for that.
Sarah Simpson, her social worker, encourages her that they’ll work on that. She wants Christie to feel like she taught the foster mother how to care for her baby, because she knows him best.
“You can think of her as a babysitter if you like,” Simpson tells her.
Christie nods, still staring down at Sam, now quiet and sleeping in her lap.
“Thanks for that,” she says quietly.
On – 14 May, 2017 By Molly Hayes