Maternal Education and Newborn Withdrawal Project
Title: Maternal Education and Newborn Withdrawal Project
- OB and NICU staff will be able to identify timing of NAS symptoms based on maternal medications
- Staff will be able to describe benefits of individualized educational sessions
- Mothers will express an understanding of NAS
Purpose for the program: We have seen a sharp increase in the number of women who are delivering infants at Saint Joseph’s Children’s that are receiving either Methadone or Subutex, but are not receiving any information while they are pregnant about the possible effects those medications may have on their infants. Within a six month period we had six infants at the same time in the neonatal intensive care unit (NICU) with neonatal abstinence syndrome (NAS), because they were born to mothers who were receiving methadone. A microsystem analysis confirmed a gap in the education pregnant women receiving Methadone or Subutex were receiving related to infant withdrawal and was the first step of the Maternal Education and Neonatal Withdrawal Program.
Proposed change: Women who are identified through the obstetrics clinic or the alcohol and other drug abuse clinic that are receiving Subutex or Methadone will be offered individualized time with a nurse from the NICU to go over a booklet that has been developed explaining NAS, and what she, her significant other, and family can expect from an infant with NAS.
Implementation, outcomes and evaluation: Initial meetings were held and because the project involved hospital and clinic personnel, the project went to the internal review boards (IRB) of both facilities and did not need to have IRB approval. The booklet was developed, and printed. The physicians from the clinic have since had the NICU nurse meeting with women using narcotic pain medications throughout their pregnancies, and will deliver infants who will be at risk for NAS as well as 2 women on Subutex.
Of the women that have been through the education program, 3 have delivered. The evaluations from the women at the time of the education session was positive and no improvement was needed; the evaluation after deliver was that they felt more prepared to cope with their infant and no improvement was needed.
Implications for nursing practice: We had not anticipated the physicians from the OB clinic to use this program for the education of those women on long-term narcotic pain medication; but a definite need was identified. Another need identified was an educational need for the staff on when to observe for the signs and symptoms of NAS related to the medications the mother is taking.
Keywords: NAS, Individualized teaching, maternal narcotic pain medication