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Canada Keep newborns with opioid withdrawal, mothers together: Canadian Paediatric Society

Document issued by the Canadian Paediatric Society reflects a shift in paradigm in the way babies exposed to opioids are managed.

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In response to the growing number of babies born to mothers with opioid dependency, the Canadian Paediatric Society has issued a document that supports keeping mothers and babies together to improve health outcomes, and encourages the use of skin-to-skin contact and breastfeeding to manage withdrawal symptoms in newborns.

The document released Thursday reflects a shift in paradigm in the way babies exposed to opioids are managed, from one in which newborns have traditionally been separated from their mothers and treated in neonatal intensive care units, to a family-centred model.

Dr. Thierry Lacaze, chair of the Canadian Paediatric Society's fetus and newborn committee, says women who use opioids already tend to feel guilty about the impact their drug use may have on their infants.

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"This whole concept of keeping them together and supporting them to ensure that babies and mothers will have a better outcome is also … to avoid stigmatization, to tell those women, 'You are on opioids, we are going to help you,' " he says. "So basically, we move from a kind of a stigmatization perspective to a very different approach."

Dr. Lacaze says the Canadian Paediatric Society began working on the document two years ago when it recognized the need to provide some guidance on how to treat a growing number of pregnant women and babies affected by the opioid epidemic. Nearly 1,850 babies were born with neonatal abstinence syndrome, a set of symptoms that occur when babies experience withdrawal, in the 2016/2017 reporting year, up 27 per cent from 2012/2013, according to data from the Canadian Institute for Health Information, not including Quebec.

The document Dr. Lacaze and his committee produced does not provide formal recommendations for practitioners, but is instead considered a practice point, offering a review of the latest research. Dr. Lacaze says it will help health-care practitioners seek the resources and support they need from hospital administrators and policy-makers to carry out the practices outlined in the document, and will also provide doctors with guidelines on which drugs to use, if needed, and how to progressively wean babies off medication.

The document supports a practice called rooming-in, in which mothers and babies remain together during their hospital stay, which it says has been shown to have a number of benefits, including higher rates of breastfeeding, stronger bonding, less need for medication and shorter hospital stays.

Adam Newman, a family doctor who specializes in obstetrics and addiction medicine, says the practice point is a positive development and promotes a change that is long overdue. Dr. Newman, who helped implement a rooming-in program at Kingston General Hospital in 2013 and was not involved in creating the Canadian Paediatric Society's document, says doctors have recognized for decades that separating babies from their mothers is both unnecessary and detrimental.

"All babies should be with their mothers, period. So why do we make such great efforts and spend so much money separating the most vulnerable segment of babies from their mothers?" he says.

Dr. Newman is part of a group that is pushing for the development of a residential facility in Kingston that would allow women to stay with their children while they work on their recovery – a project that extends the rooming-in concept beyond neonatal care.

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Dr. Lacaze says while the rooming-in model may seem straightforward, hospitals are not traditionally set up to keep mothers and babies together. The common practice five to 10 years ago was to observe the babies of mothers who were known to be using opioids in a hospital nursery for one to three days after birth, Dr. Lacaze says. If the babies developed withdrawal symptoms, they were typically transferred to the neonatal intensive care unit, where they remained for two or three weeks and were usually given morphine and slowly weaned off, he says. In the meantime, the mothers were discharged from hospital, which did not encourage breastfeeding and bonding.

Even though hospitals are now moving toward keeping women and babies together as much as possible, Dr. Lacaze says, many do not have the space to allow mothers to stay for two to three weeks while their babies are treated. A rooming-in model also requires nurses, social workers and care providers who are specially trained to deal with babies with neonatal abstinence syndrome, as well as environments that offer infants low lighting and minimal stimulation.

"It sounds simple on the paper, but this kind of change is always challenging because it's a system issue. So we have to change the system," Dr. Lacaze says.

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