Recently the Centers for Disease Control and Prevention (CDC) released a report showing that the rate of opioid use among American women during childbirth more than quadrupled between 1999-2014. Opioid use and dependence among women of childbearing age in the U.S. and worldwide is a substantial problem that shows little indication of subsiding. It’s an issue among all races and socioeconomic levels as well as all geographic regions–some areas have seen alarming increases.
Not surprisingly, the number of infants born with Neonatal Abstinence Syndrome (NAS) has also increased. NAS is a multisystem syndrome where infants may exhibit a wide array of symptoms and co-conditions that could result from being exposed to opioids during pregnancy. Infants diagnosed with NAS suffer from acute withdrawal symptoms immediately after birth and subsequent long-term developmental and body system difficulties, often lasting well into childhood and beyond. The health care burden and accrued costs for both the opioid dependent mothers and opioid exposed infants continue to climb, outpacing available resources and programs.
All too often, patients are prescribed opioids for pain (often after injuries or surgeries) without a concrete follow-up plan, which can lead people into a state of dependency. However, the CDC suggests providers can help combat the opioid epidemic by aligning their actions with evidenced-based practices for pain management. This includes judiciously prescribing pain management therapies, following clinical guidelines, and providing patient-centered care that respects each person’s unique diagnosis, condition, pain management plan, and future goals.
But when is the best time to intervene for pregnant women with an opioid dependency?
We can minimize opioid exposure to the infant and improve health outcomes for mother and child by connecting expectant mothers to opioid treatment, such as methadone or buprenorphine. They can still give birth to an infant diagnosed with NAS, but the infant’s symptoms tend to be less severe. Additionally, an often overlooked non-pharmacological treatment for newborns with NAS is breastfeeding. This is an option if a mother is in an opioid recovery program and not using any illicit substances; it’s been shown to reduce the need for withdrawal treatment in opioid exposed newborns.
As providers, we must arrange for pregnant women to deliver in facilities that are equipped to care for infants born with NAS and that provide supportive services for the mother before and after delivery. The key word here is ‘supportive.’ All too often, there is an intense stigma on pregnant women who have become dependent on opioids, let alone those who have delivered an infant diagnosed with NAS. The fear that their infant will be taken away is real. Mothers are so fearful that they may not tell their health care providers about their dependency, which leads to ineffective care.
Every mother (and family) must be given the opportunity to receive care for their opioid dependency by all health care professionals involved in their pregnancy without fear of stigma. This is why it will take a village—the whole health care team—and we are at the crossroads. Do we continue down the current path or change course? It is our moral and ethical responsibility as health care professionals to promote responsible care for recovering breastfeeding mothers and newborns with opioid dependence to support their recovery.
Substance recovery cannot be treated in isolation, and the interdisciplinary professional team effort—the village—promises the greatest chances for recovery success. With appropriate support grounded in evidenced based practices many women can overcome the biases and obstacles associated with opioid recovery, achieve successful pain management, and plan a healthy future for themselves, their newborns, and their families.
September is Pain Awareness Month, a time when various organizations work together to raise awareness of issues in pain and pain management.
- Believe Me When I Say That I’m In Pain
- US opioids: number of addicted women giving birth quadrupled over 15 years
- Tennessee women battling addiction – photo essay
Deborah Busch, DNP, CPNP, IBCLC, Pediatric Nurse Practitioner and International Board-Certified Lactation Consultant
JoAnne Silbert-Flagg, DNP, CPNP, IBCLC, FAAN Pediatric Nurse Practitioner and International Board-Certified Lactation Consultant