Off the crooked path


Moms recovering from substance abuse choose the straight road for their babies

Coming into the world was the easy part for Nevaeh Aldana.

Born July 7, 10 weeks premature, the baby girl with dark, wispy hair was immediately whisked away to the hospital’s neonatal intensive care unit, where she was evaluated and put on a respirator to support her underdeveloped lungs.

But in addition to observing Nevaeh for health issues related to prematurity, the nurses were watching to see if she would develop neonatal abstinence syndrome (NAS), withdrawal from the methadone her mother had been prescribed during pregnancy to manage her heroin addiction. Even though methadone may still cause NAS, it is considered safer during pregnancy than heroin use or abrupt withdrawal, which can lead to miscarriage.

Before long, the tiny newborn began withdrawing. She cried inconsolably and had trouble sleeping for longer than an hour at a time. Already weighing less than 4 pounds, she had little interest in eating. She vomited and had diarrhea. Like many babies with NAS, she was sensitive to being touched, making it difficult to comfort her.

The nurses began the standard treatment, giving Nevaeh medication similar to the methadone her mother had been taking. The goal: gradually weaning her off of the drug. It took five weeks. On Aug. 20, Nevaeh went home.

But her care didn’t stop there.

Soothing babies through science

Lisa Cleveland, Ph.D., RN, PNP-BC, IBCLC, works with Yolanda Aldana and her baby, Nevaeh, on Kangaroo Mother Care techniques. Aldana and her daughter are part of the Mommies Program, a community-based counseling and parenting program for mothers recovering from substance abuse.

The majority of babies exposed to opioid drugs while in the womb, between 60 and 94 percent, develop neonatal abstinence syndrome. NAS often includes symptoms such as Nevaeh’s, but can also result in seizures and, in rare cases, death.

Yet nationwide, opioid use among pregnant women has skyrocketed, resulting in a 300 percent increase in babies born with the syndrome since 2000.

“Often, women with substance use disorders have experienced trauma, such as childhood abuse and neglect, and have co-occurring mental illness,” said Lisa Cleveland, Ph.D., RN, PNP-BC, IBCLC, assistant professor in the School of Nursing.

Over the past five years, Texas has seen a 60 percent increase in NAS cases, with Bexar County leading the state in the number of babies born with the syndrome.

In 2007, the Mommies Program was created to offer these mothers and their babies a wide range of support, including methadone treatment for mothers during pregnancy, a recovery program after the baby’s birth, counseling and a 13-week series of parenting and life-skills classes.

Nevaeh’s mother, Yolanda Aldana, 25, is one of the more than 600 women who have participated in the community-based counseling and parenting program, a partnership among the Center for Health Care Services, University Health System, the Department of State Health Services and the School of Nursing.

“There is such a stigma associated with being a mother who has a substance use disorder, particularly when interfacing with health care providers. This can create additional barriers for women seeking treatment,” said Dr. Cleveland, a NICU nurse for 12 years before becoming a pediatric nurse practitioner and researcher.

It can also interfere with the mother-child bonding process. Although mothers are discharged from the hospital within a few days, most babies with NAS stay in the NICU for more than two weeks.

“After interviewing several mothers whose infants had NAS, I realized that their experiences were different than other NICU mothers,” Dr. Cleveland said. “They had overwhelming feelings of shame and guilt. These feelings could be so strong that some mothers wouldn’t come to the NICU to visit their babies.”

Since the Mommies Program began, the time babies with NAS stay in the NICU has decreased by 33 percent. Aiding in the process are medications to alleviate some symptoms and soothing techniques such as Kangaroo Mother Care, often used with premature babies that promotes continuous skin-to-skin contact between the mom and baby and provides comfort to both.

“[Kangaroo Mother Care] has been used for years with preterm infants, resulting in dramatically improved outcomes for mothers and infants. It is often recommended for infants with NAS, but there has been little evidence to show if it’s effective,” Dr. Cleveland said.

In 2014, Dr. Cleveland received $204,000 from the Department of State Health Services to investigate the impact of Kangaroo Mother Care on stress and attachment in mothers and babies suffering from the effects of substance abuse.

Dr. Cleveland’s project is multipronged. First, she teaches mothers about Kangaroo Mother Care. The idea behind the technique is to snuggle the baby, dressed in only a diaper, against the mother’s bare skin, allowing the baby to smell her mother and hear her mother’s heartbeat. This also makes on-demand breastfeeding, an important aspect of NAS recovery, more likely.

Then, using the School of Nursing’s Biobehavioral Research Laboratory, the saliva of both mothers and the infants is tested to measure cortisol levels. Cortisol is a biomarker of stress. Samples are collected before Kangaroo Mother Care begins and again 20 minutes later. The data will determine if the technique improves attachment and reduces stress reactivity in mothers and babies with NAS.

Dr. Cleveland is also evaluating whether Kangaroo Mother Care further lowers infants’ need for medication, lessens the length and cost of hospital stays and reduces placement of the children in foster care or with other relatives.

Based on the study’s early success, Dr. Cleveland has been awarded an additional $50,000 from the Department of State Health Services to expand the Mommies Program to other area hospitals and include more mother and baby pairs.

The grant is also helping the Mommies Program expand to other areas of the state. A writing team led by Dr. Cleveland published The Mommies Toolkit for the Department of State Health Services, outlining how other communities can add resources similar to the Mommies Program. They held workshops about the program with community agencies from the counties with the highest rates of NAS, such as Dallas, Harris, Nueces and Tarrant counties.

Heart to heart

On a recent morning, Yolanda demonstrated Kangaroo Mother Care with Nevaeh. Yolanda undressed Nevaeh to her diaper, tucked her inside of her blouse and placed her on her bare chest. Nevaeh quickly fell into a deep sleep.

With Nevaeh safely snuggled to her chest, Yolanda said she feels grateful for the opportunity to participate in the Mommies Program and be part of the Kangaroo Mother Care study. It has helped the pair bond.

“I love the feeling of Vaeh’s heartbeat. It’s like she’s still in my womb,” she said. “I remember the first time I held her like this. My heart just melted.”

She also remembers the day she was discharged from the hospital, forced to leave her baby behind.

“I felt horrible. Seeing what Vaeh was going through was terrible,” she said. “My mother said that the reason I was in this situation was because I took the crooked path. I am never going to put myself in this situation again.”

She is continuing with the Mommies Program and still uses Kangaroo Mother Care with Nevaeh, even after bringing her home.

“These mothers are so strong. They never cease to amaze and inspire me,” Dr. Cleveland said. “Their strength comes from their children.”

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