White Coat, Black Art

A cuddle from mum instead of morphine: How rooming in helps opioid-dependent newborns combat withdrawal

A growing body of evidence shows a rooming-in approach, which allows mothers and babies to stay together in a private room and bond through skin-to-skin contact and breastfeeding, can be as effective as drugs in combating infants' withdrawal symptoms.

Rooming in allows mothers, who are dependent on opioids to bond with newborns experiencing withdrawal

Nicole Francis with her children, Everley, 3, and Camden, 6 months. Both children roomed in with their mother to help ease the symptoms of withdrawal. (Dr. Brian Goldman/CBC)
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When Nicole Francis laid eyes on her newborn daughter Everley for the first time, she recalls "bawling my eyes out" in joy — and relief. 

"I kept thinking my whole pregnancy that something was going to go wrong — that my stupid mistakes would start to follow me and catch up — and unfortunately, she would be the one to bear it," said the Kingston, Ont., mother of two.  

Before she got pregnant with Everley, Francis had been struggling with an addiction to Percocet, an opioid she was prescribed after breaking her arm in 2010 during a night out with friends.

She had just started on the road to recovery by going on Suboxone, a prescription drug used to treat opioid addiction, when she found out she was pregnant.   

"I was shocked and my first concern was, is this baby OK?" she told Dr. Brian Goldman, host of White Coat, Black Art.

When I think of withdrawal, I only know it as how I feel it, which is like dying. So then you start to think does a baby feel this way, too? - Nicole Francis

Opioids can pass through the placenta from mother to baby, leaving the baby dependent and putting them in withdrawal once they are born, a condition called neonatal abstinence syndrome (NAS). Symptoms of NAS include vomiting, diarrhea, high-pitched cries, seizures, dehydration, fever, sneezing and tremors, which can seriously compromise the health of infants.  

Between 2016 and 2017, about 1,850 babies were born with NAS, according to the Canadian Institute for Health Information. The rate of hospitalizations for neonatal withdrawal symptoms increased by 21 percent between 2013 and 2017.

Rooming-in approach

While Francis was no longer taking Percocet when she got pregnant, Everley would still face withdrawal from the Suboxone she was taking to treat her addiction. 

Nicole Francis with her daughter Everley, 3. Nicole was on Suboxone when she gave birth to Everley and roomed in with her at Kingston General Hospital. (Dr. Brian Goldman/CBC)

"It's your first baby, so you're questioning two things now: Is this what a normal baby does, or is this what happens in withdrawal? Because when I think of withdrawal, I only know it as how I feel it, which is like dying. So then you start to think does a baby feel this way, too?" 

Typically, hospitals put babies with NAS in the neonatal intensive care unit (NICU) for several weeks to monitor them, while treating their withdrawal with small doses of morphine. 

In some cases, child protection authorities intervene if they think the child is at risk, a thought that terrified Francis.

"Your mind kind of runs wild," she said. 

But a growing body of evidence shows a rooming-in approach, which allow mothers and babies to stay together in a private room and bond through skin-to-skin contact and breastfeeding, can be as effective as drugs in combating infants' withdrawal symptoms.

Dr. Adam Newman, a family physician in Kingston, Ont., who specializes in pregnancy and opioid addiction brought the rooming-in program to Kingston General Hospital. (Brian Goldman/CBC)

"It's very dramatic. If you take its clothes off, put its naked skin against its mother's naked skin and let her nuzzle it between her breasts, it's like giving it medicine. I mean, it's better than morphine," said Dr. Adam Newman, a leading proponent of rooming in.

He first read about the phenomenon in studies by researchers at the B.C. Women's Hospital and eventually went to B.C. to see it for himself. 

"Even though the discomfort was supposedly caused by absence of opioids, you could comfort and console the baby by cuddling it. And it happens immediately," he said. 

The Canadian Paediatric Society also backs the approach, releasing new guidelines in 2018 advising that babies with NAS and their mothers should room together when feasible, rather than the baby being sent to intensive care. 

Often times, "the mother would be shunted off to the usual postpartum ward with other mothers — sometimes up to three other mothers with their babies — listening to their babies crying and thinking that her baby is separated from her because she has done this terrible thing," Newman noted.

While he says the intention on all parts is benevolent, it's heartbreaking and damaging for mothers, who are usually discharged before their baby and leave the hospital feeling stigmatised and shamed. 

Mother just does 'mothering' 

Newman began a rooming-in pilot at Kingston General Hospital in 2013, which is now the standard of care at the hospital.

Twenty-one mothers participated that first year. Newman estimates the program saved the hospital $400,000 due to reductions in the use of morphine and shorter stays in the NICU. The average length decreased from 25 days to eight days for babies. 

"AlI I do is sign off and say, 'Please admit this mother and baby to a private room for medical reasons…And then the mother just does mothering. She just cuddles the baby and nurses it." 

Francis was on Suboxone when her son Camden was born, and they roomed in together at Kingston General Hospital. (Dr. Brian Goldman/CBC)

Babies and mothers typically room-in for five days, concentrating on breastfeeding and skin-to-skin contact while being supported by staff. 

Nicole Francis roomed in with her daughter Everley, now three, and her son Camden, who was born earlier this year. 

"(The nurses) would come in every eight hours and they would look for signs, and see if she was sneezing excessively, see if there was any fever, any strong type of irritability," she said, recalling Everley's birth. 

She remains grateful for the program. 

What's the disadvantage of letting a baby stay with their mother?- Nicole Francis

"If I were to go to say, Petawawa, [Ont.,] where my family is, where they don't have their rooming-in programs… I wouldn't be with my baby. They would be in the NICU on a morphine drip." 

Kingston is one of a handful of facilities outside of B.C. Women's Hospital to offer the program. Belleville General Hospital, not far from Kingston, is another. 

In the eight months since Francis and her son Camden roomed in, she has returned to work part-time and her daughter started daycare. She believes the program helped her family get a strong start, and it could do the same for others if it was more widely practised.

"From what I have experienced in the rooming-in program, the privilege that I was given of spending time with my babies when I'd first had them ... I don't see any negative impact.... like, what's the disadvantage of letting a baby stay with their mother?" 


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