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Jessica Kreck

Neonatal Abstinence Syndrome

Germanna Community College

Abstract

In this problem-solution research paper I use nine references to investigate and propose a

solution to stop newborns born addicted to opioids and other substances. With firsthand

experience working in Labor and Delivery, this problem is very real. Babies born addicted to

opioids go through withdrawal just as a mother would. The condition is called Neonatal

Abstinence Syndrome, and it is traumatic for infants, mothers, and clinicians. Mothers are often

treated as criminals when they expose themselves as drug abusers to their clinicians. This has

been proven to harm the fetus as expectant mothers refrain from returning to the doctor they

thought they could trust. With addiction prevention starting in the community, schools,

treatment facilities, and clinical offices the rate that a newborn will suffer from Neonatal

Abstinence Syndrome will be significantly lower than if these preventions were not offered.
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“A woman wakes up in her hospital bed, and the nurses tell her she had her baby. She

does not remember much about it, and she does not want to see her child. She wants relief. She

spends the next few days in bed going through withdrawal. Her baby does, too. The night that

she last abused drugs was the same night she gave birth. When she finally met her newborn

baby boy, she realized how sick he was. He was suffering direly from her drug use.” She never

saw him again (Claire Menzel, 2015).

The rate that a newborn will be admitted to a Neonatal Intensive Care Unit has increased

rapidly due to Neonatal Abstinence Syndrome (NAS). This is a group of consequences that a

newborn will face due to being exposed in utero to addictive opiate drugs. Across the country,

the number of pregnant women with opioid use disorder quadrupled from 1999 to 2014. Opioid

use includes drugs such as oxycodone, codeine, morphine, methadone, suboxone, heroin, and

fentanyl. They can be prescribed or obtained illegally. As a result, the baby becomes dependent

on the drug. Cultivating a solution for drug abuse in pregnant women has become an epidemic

across the United States. Promoting healthy outcomes and reducing the stigma and fear

associated with illicit drug use can be potentially alleviated by initiating a positive relationship in

the prenatal office between provider and mother, attacking the problem through population

health, and primary prevention (Faherty, Matone, Passarella, & Lorch, 2018).

A fetus that is exposed to drugs will become dependent just like the mother. The sudden

lack of the substance will cause withdrawal symptoms after the baby is born known as NAS.

Central nervous system irritability, tremors, increased muscle tone, high-pitched crying, seizures,

feeding difficulty, and temperature instability compile the list of symptoms an infant will suffer

from with this syndrome. Among 28 states with publicly available data during 1999-2013,
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infants born dependent on illicit drugs increased 300%, from 1.5 per 1000 hospital births in

1999, to 6.0 per 1000 births in 2013 (Roussos-Ross, Reisfield, Elliot, Dalton, & Gold, 2015).

“Untreated opioid use disorder during pregnancy can have devastating effects on the

fetus.” The changes in the levels of opioids in the blood of mothers that are using opioids expose

their unborn baby to withdrawal repeatedly. “This can harm the function of the placenta and

increase the risk of fetal growth restriction, placental abruption, preterm labor, fetal convulsions,

and fetal death.” To lessen the negative effects of opioid dependence on the unborn baby,

methadone and buprenorphine have been used for pregnant women with opioid use disorder.

Although NAS will still occur in babies whose mothers receive this treatment, the withdrawal

sustained is not as severe as it would be without the medication (Roussos-Ross, Reisfield, Elliot,

Dalton, & Gold, 2015).

In order to effectively treat NAS a score is used to evaluate the baby’s signs of

dependence and withdrawal. Samples of the baby’s blood, urine, and stool are collected to test

for drugs. “Treatment options can range from making the infant more comfortable by

minimizing exposure to light and sound, or swaddling and rocking, to medication to reduce more

severe withdrawal symptoms.” Pharmacological treatment is introduced to prevent fever, weight

loss, and seizures if the baby is not responding to therapeutic measures. The mother, battling

separation anxiety, will fight the strong urge to use again to cope with the intense loss (Sublett,

2019) (Faherty, Matone, Passarella, & Lorch, 2018).

To protect unborn babies from addiction laws were put into place to criminalize pregnant

women using drugs. However, when moms were threatened with jail time and to remove them
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from their care the number of newborns who contend with drug withdrawal jumped significantly.

The lack of compassion towards the mothers discourages them from seeking addiction treatment

and puts their babies at a greater risk of health problems from the moment they are born. If the

mother faces jail time, the fetus is at risk for abrupt withdrawal resulting in stress and death.

Taking disciplinary actions during a time when women are in their most vulnerable period is not

the best policy (Reising, Bergren, & Bennett, 2019).

Rather than punishing and demoralizing a woman who faces pregnancy under less than

ideal circumstances more should be done to provide her with empathy and the care that is right

for her in her time of need. Women who are addicted will not benefit from harsh judgement and

arbitrary punishment, but they will benefit from education, assistance, and compassion. The

outcomes for the unborn baby will be higher when a positive relationship is built between the

pregnant mother and the care team. The stigma and fear harbored by society and clinicians

needs to be diminished (Reising, Bergren, & Bennett, 2019).

Medication-assisted treatment of opioid maintenance rather than detoxification for

pregnant women is more effective and reduces the impact on the developing fetus. In addition,

women who were treated through methadone maintenance were more likely to stay in treatment

longer, were more consistent with obstetric appointments, and delivered their babies at the

hospital where their program was offered (Winklebaur, Ebnar, Kopf, Jung, Thau, Fisher, 2008).

“Maternal opioid use primarily impacts low-income women and infants who receive

medical care covered by Medicaid.”  In 2004 73% of NAS related births were paid for through

Medicaid. That number rose to 82% in 2014. The total for hospital costs for NAS births that

were covered by Medicaid increased from $65.4 million in 2004 to $462 million in 2014 (Moore,

2018) (Roussos-Ross, Reisfield, Elliot, Dalton, & Gold, 2015).

A public-health approach that target patients, family, and community level factors will be

necessary to prevent opioid use disorders in pregnant women.  Women that are high risk for

substance abuse because of mental health disorders need to be screened and treated to reduce the

chance of reproduction. Adolescents with unhealthy parental relationships may benefit from

family-based therapy.  “Low socionomic status and unemployment are strong predictors of

opioid use. Improving affordable health insurance coverage for low-income women before

pregnancy would expand access to substance use disorder treatment and could reduce NAS

related morbidity” (Kolodny, Courtwright, Hwang, Kreiner, Eadie, Clark, & Alexander, 2015).

    Contraception use among women that use opioids and other substances is at 30%

(Conford, et al 2015). To lower the risk of unwanted pregnancies and NAS women need to

consent to taking contraceptives in order to get medically prescribed opioids. There is

opportunity to implement policies in order to prevent pregnancies and reduce the risk of NAS.

Access to treatment for women before, during, and after pregnancy will play a critical role in the

outcomes for mothers and their babies. (Terplan M, 2015). 

Prevention of opioid use needs to take place in the community before there is any sign of

a problem. By using school-based youth prevention programs, public education and stigma

reduction campaigns can prevent opioid misuse and dependence from ever developing. “The

concept of prevention at a primary, secondary, and tertiary level” has been widely adopted for

many noncommunicable diseases of significance such as diabetes, hypertension, and cancer, and

needs to be proposed as a reasonable schema to reduce opioid dependence that results in

Neonatal Abstinence Syndrome (Winklbaur, Ebnar, Kopf, Jung, Thau, Fisher, 2008).
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Comprehensive addiction education among adolescents can be the catalyst behind

making a change in opioid addiction in pregnant women. Nurses and other health care

professionals can play a vital role in the care of persons with addiction. Being treated by

providers with distain and rejection, no matter how subtly, the addicted mother will reject care,

and miss opportunity for treatment. While being nonjudgmental and treating mothers with

kindness and compassion will not save all of them from harm, it could help many mothers and

newborns.
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References

Faherty, Laura J., Matone, Meredith, Passarella, Molly, & Lorch, Scott. (2018). Mental Health of

Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Opioid Exposure.

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Women and the Increase in Neonatal Abstinence Syndrome: What Is the Cost? Journal

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Reising, V. A., Bergren, M. D., & Bennett, A. (2019). Care and Treatment Recommendations for

Pregnant Women with Opioid Use Disorder. MCN, The American Journal of

Maternal/Child Nursing, 44(4), 212–218.

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