FARMERSBURG, Ind. (WTWO/WAWV) — Every 15 minutes in the United States, a baby is born drug dependent.
The condition is called neonatal abstinence syndrome, or NAS, and data from the Indiana State Department of Health (ISDH) indicates that it is a prevalent issue for Hoosier families.
The ISDH data shows a diagnosis rate for NAS of 12.1 out of every 1000 babies born in Indiana. This is nearly double the U.S. average diagnosis rate of 6.7 out of every 1000 births.
These babies suffer from symptoms of irritability and sleeplessness.
“The normal mom would rock a baby to sleep, they prefer to be swayed,” Margaret Suozzi, Director of Women/Children Nursing at Good Samaritan Hospital, said. “They don’t do well in crowds, they don’t do well in bright lights, or lots of music, TV, a variety of things.”
NAS babies can also experience more serious symptoms like seizures, and can also see the effects later in life, such as learning disabilities and developmental delays.
The high rate at which Indiana health providers prescribe opioids is considered to be one source of the addiction that leads to babies born with NAS.
According to the CDC, Indiana providers wrote an average of 74.2 prescriptions per 100 persons in 2017. The U.S. average was 58.7 prescriptions per 100 persons in the same year.
In the Wabash Valley, where there are several rural communities, addiction, and consequently NAS, can be traced to several socioeconomic factors factors.
“We have a high Medicaid population, we have women who choose not to breastfeed, we have a high obesity population,” Suozzi said.
The Central Southwest region of Indiana also has a higher smoking percentage than the state as a whole: 20.1% compared to 13.5%.
There is also a stigma surrounding addiction that Carolyn Suniga, a perinatal social worker with Greene County General Hospital (GCGH), said can lead to an expecting mother not reaching out for help.
“Because of the pregnancy, the addiction is uncovered,” Suniga said. “There’s a lot of shame in that area. I also think that behaviorally, there’s a different culture when it comes to rural mental health. I don’t think there’s a mother or father out there that doesn’t care about the baby, but because of the addiction issues and some of the needs in the county, there’s barriers to getting where they want to go with their family.”
Indiana State Health Commissioner Dr. Kris Box said mothers are also afraid of legal consequences.
“Women were very, very concerned that automatically if we identified that they had a substance use disorder during pregnancy that their child would removed from their home when the baby was born,” Dr. Box said.
The issue of marijuana use and pregnancy:
The prevalence of NAS, and the lack of prenatal care for mothers fighting addiction, was at the center of a state-wide task force created underneath the Indiana Perinatal Quality Improvement Collaborative (IPQIC).
The IPQIC has been collecting annual data of NAS, such as the numbers mentioned earlier in the story, and using that data to figure out what programming best helps families.
One collection of data shows that from Jan. 1, 2017, to Aug. 31, 2018, 12.6% of umbilical cords that tested positive for a substance contained opiates and 16.9% of cords contained cannabinoids. All other substances showed up in less than 4% of cords tested.
In 2019, Indiana Medicaid was awarded a grant of $5.2 million to address maternal opioid use, which has extended Medicaid coverage and increased education for providers. Through these grants and other IPQIC initiatives, positions like perinatal nurse navigators have become available at hospitals in more rural communities.
“I would meet with the family, work with them during pregnancy, and even until the baby is born, until the baby is 18 months old, and then from then, I can still be a bridge to help them with other resources,” Nicole Page, perinatal nurse navigator with GCGH, said.
Page said there are several ways in which prenatal assistance can help mothers dealing with addiction. She also pointed to breastfeeding as a benefit for babies suffering from NAS symptoms.
How breastfeeding can help NAS babies:
Additionally, House Enrolled Act 1007 requires verbal screening for drug use in expecting mothers in order to get them connected with those helpful resources sooner.
“This is not so that we can report this level to DCS, that’s private healthcare information that is between that woman and her provider,” Dr. Box said.
Rather, the screenings allows mothers to get help early on and combines with other IPQIC initiatives to lower the number of babies born with a drug dependency.
Dr. Box said the efforts have already shown improvements, as 55 of 86 delivering hospitals in Indiana are engaged in the task force and are seeing results.
The average length of a hospital stay for a baby with NAS is 16 days, but Dr. Box said that number is decreasing as less babies are born with the condition.
While these efforts are showing progress, the fight to end the epidemic is far from over.
“We are very proactive,” Suozzi said. “We’re all getting better, but there’s still work to do.”
The IDSH has published several presentations regarding NAS that can further the understanding of this condition.
