Amid opioid epidemic, Phoenix nursery pioneers care for babies in withdrawal
This story comes from Call to Mind, American Public Media’s initiative to foster conversations about mental health.
In line with the rise of the opioid epidemic, over the last decade or so there has been a dramatic increase in the number of babies who were exposed to opiates in the womb. The parents of those children face a unique set of challenges including that child is likely to experience withdrawals in the first two weeks of life.
While babies experiencing withdrawal are usually treated in neonatal intensive care units, there is a growing movement of advocates for a new care model. Among the places utilizing this model is Hushabye Nursery in Phoenix, which specializes in caring for those newborns and providing support to their families.
From the outside, the unassuming building looks almost industrial and sits on a bustling, six-lane street in central Phoenix. But inside, it feels more like a sanctuary for parents. The rooms are dark and cozy, and are stocked with everything a baby needs, from diapers and formula, to light therapy and vibrating bassinets that soothe.
Joseph Fant (who usually goes by Joey) works as a peer support at Hushabye, teaching classes and running support groups for parents. He knows these rooms so well because at one time he was here, with his baby.
“I used for about a decade,” said Fant. “Personally, I used heroin. I had so many failed attempts to get sober.”
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Fant said that having his child, while an immense responsibility, gave him much-needed perspective.
“I think it was a catalyst for me, like I get to have this little tiny human who I talked with, not even 24 hours old, I'm like talking to him, ‘Hey buddy – how am I gonna take care of you?’”
Fant knew he wanted to get sober before his son was born. And then one day he saw a poster for Hushabye on the wall at his methadone clinic. He went to a meeting they organized, where he met Hushabye’s executive director Tara Sundem. Sundem is a neonatal nurse practitioner who used to work in the neonatal intensive care unit at a hospital. The NICU cares for newborns with many different health issues, and in 2015 Sundem noticed an influx of babies who were experiencing neonatal abstinence syndrome, or NAS.
NAS refers to a set of symptoms that can occur when a newborn is withdrawing from certain substances, like opioids. An investigation published in 2021 found that, between 2010 and 2017, the number of babies born with NAS increased 82 percent nationally, according to the Centers for Disease Control and Prevention. The CDC also cites data which says that 80 newborns are diagnosed with NAS in the United States every day.
How Hushabye is different from a NICU
Sundem says that babies born with NAS have symptoms that make the NICU a particularly challenging environment for them. It’s full of bright lights and machines that beep, and nurses are often pressed for time.
“One mom explained to me withdrawal as being the worst flu and migraine times a hundred. So vomiting, diarrhea, inability to sleep,” said Sundem. In babies, NAS can also cause fever, shaking, high-pitched crying and even seizures.
Sundem wanted to create an environment specifically designed to care for babies in withdrawal that takes into account all of these symptoms. She opened Hushabye’s physical space in November 2020, though she had been coordinating prenatal programs for a few years before that.
Where the NICU can be bright, loud, and chaotic, Hushabye is quiet and feels gentler.
Sundem says Hushabye’s staff does their best to get in touch with pregnant people before they give birth, because they’re likely to have a better experience and more positive outcomes that way. Since that’s not always doable, some come after they’ve given birth and may have spent some time in the NICU. Hushabye says the majority of the families who use their services are on Medicaid, which covers the baby’s care in many cases.
Hushabye’s staff also try to maintain a one-to-one staff-to-baby ratio, and to hold babies whenever they’re awake. The staff also uses a trauma-informed approach when working with parents who may still be experiencing substance use disorder. Their belief is that parents are the best medicine for their own babies, so staff try their best to meet parents where they are, even if that’s a rough place.
Sundem feels so strongly about having these best practices at Hushabye because of her experiences in the NICU. She recalled one moment when a baby in the hospital had finally gotten to sleep, and the baby’s mom showed up for a visit.
“She was so excited to see her baby, and the nurse looked at the mom and pointed at her and said, ‘Don't touch your baby,’” said Sundem. “The mom just like immediately just stopped in her tracks.
“What the nurse, I believe, meant was that her baby just fell asleep, and stay here, sit at the bedside. She sat there for an hour. When she left that day, she never came back,” said Sundem.
‘Eat, Sleep, Console’
In addition to trauma-informed language and compassionate care, Hushabye and other places with a similar philosophy use a new care model called “Eat, Sleep, Console.”
Jocelyn Maurer, a NICU nurse at Banner University Medical Center in Tucson, explained they evaluate the infants by asking the following questions: “Can they eat a normal amount for a baby their age? Can they sleep for at least an hour at a time without their withdrawal symptoms waking them up? And can they be consoled in a reasonable amount of time if they do become fussy?”
Programs that use Eat, Sleep, Console, while relatively new, tend to have shorter stays, use fewer narcotics on babies than hospitals do and, according to Tara Sundem, view the health of the child from a broader perspective. Though the use of this model is growing, Hushabye says they are the first facility that includes wraparound services where parents can stay in the room with their baby. In fact, Hushabye is so unique, they received an innovation award from the Substance Abuse and Mental Health Services Administration, which is part of the U.S. Department of Health and Human Services.
“Not baby-centered, but family-centered,” said Sundem. “It's the whole entire family that we need to heal to reduce the number of adverse childhood experiences to make this baby have the best outcome possible for them to thrive and be healthy.”
Cassie Freund, who has used Hushabye since her now 10-month-old daughter was born, remembers the judgment she felt right after she gave birth.
“I was scared everyone was out to get me and take my baby away,” said Freund. “Everybody wants to know what I've done wrong and I'm tracked up everywhere and these marks are gonna give me away to everybody. And they're gonna be like, ‘She doesn't deserve this baby.’”
Hushabye helped Freund get settled with her new baby and navigate working with the Arizona Department of Child Safety. She stayed sober and improved relationships with her family, which gave her a lot of hope.
“The fact that I gave birth to this perfect baby gives me the thought that every mother that has come through here,” Freund said, “I could tell her no matter what, that it gets better.”
This story was included in Call to Mind’s program “Substance Use & New Paths to Recovery.” Listen to the full program at calltomindnow.org.