There are many things we think we know about babies, about childbirth even, through experience and family, pop culture, social cues, even hearsay. We hear about the crying, the diapers, the lack of sleep, the tiniest of bodies hooked up to an abundance of machines, where the rhythmic beeping in the back is as monotonous as it is consistent. One. Two. Three. Where tiny hearts beat and small chests rise.
What we often don’t think about is that babies can be born dependent on drugs, or more specifically, opiates. With addiction comes withdrawal. They are two sides of the same coin. Vicious aspects of a disease that affects too many; in the US alone, 21 million Americans are estimated to be facing addiction, with only 10% seeking treatment. The statistics are startling. There’s more there too, bullet points after bullet points regaling a crisis that fails to be fixed, that continues to trend in an undesirable direction.
For babies, it’s called Neonatal Abstinence Syndrome, or NAS. Newborns are suddenly thrust into a world where they’re not only out of the womb, but dealing with withdrawal, since the supply of drugs through the umbilical cord has been cut, both literally and figuratively.
Based on National Institute of Health (NIH) data, maternal opioid use and NAS-born babies have been on the rise, a net 333% increase between 1999 and 2014. A 2014 metric estimated that every 15 minutes, a baby is born with opioid withdrawal. 15 minutes. That’s sometimes how long it takes to get through a drive-thru or your morning cup of coffee.
More recent data shows there is an NAS diagnosis every 25 minutes. I didn’t believe my eyes when I read it the first time. I double checked. Then triple checked. But you read it right, every 25 minutes.
I’ve worked with babies before, I’ve volunteered in the NICU and seen just how small an actual human being can be, but treating NAS, treating withdrawal in a newborn is an entirely different beast than it is with adults. There’s pharmacological and nonpharmacological approaches. But there’s more nuance to the actual care delivery for NAS babies beyond the standard NICU set up.
Here’s where I introduce you to Hushabye Nursery. When I was invited to sit in on this call, I hadn’t given too much thought to the name on the email invite. Thus far, all the interviews I was able to witness with Kipu clients pertained to behavioral health or substance abuse in the adult population. Even if ‘Hushabye’ wasn’t a direct giveaway, ‘Nursery’ should have been, but hey, hindsight is 20/20. I didn’t even think that an outpatient facility, separated from hospital NICUs, would offer not just alternatives, but better means for care.
It seems almost counterintuitive, no? After all, most things have been medicalized in the age of modern medicine and hospitals are considered to be the best equipped for most health crises.
But here’s the thing about healthcare delivery. There are many ways to do it. Some ways that are deemed better by time-honored tradition, others by way of new innovation and discovery. Sometimes, though, the status quo needs to change. Alterations in approach, no matter how small, may be the literal difference between life and death.
Take Kangaroo Care for example. It’s what they call that vital skin-to-skin contact for NICU babies, recommended during the “Golden Hour,” the first, and most crucial, 60 minutes post- birth where outcomes improve for both mom and baby. First developed in the 70s in Bogota, Colombia, in response to high death rates for preterm infants, it’s now become an evidence-based approach to improving weight, breathing, oxygen saturation, breastfeeding efficacy, and even bonding between parent and baby.
What was once an approach to helping pre-term babies has now become a recommended course of action for all babies, regardless of premature status. It’s even being used as an additional treatment measure for NAS babies.
I’ve seen the specifics of healthcare delivery before in the abstract, in the lines of long journal articles, or in didactics focused on this type of material, where outcomes are discussed in black-and-white numbers, margins for improvement are considered, statistical trends are calculated.
But I saw it most clearly after hearing Tara Sundem, Founder and Executive Director of Hushabye Nursery. As a former neonatal nurse practitioner, she was closest to the cause. She treated countless babies diagnosed with NAS, amidst the loud and bright beeping of the NICU, where no bout of silence was without cries from various beds and chatter from the other providers. Outcomes, though, weren’t magically better surrounded by all the noise, all the providers, all the activity. It’s where Hushabye started, or for the sake of well-timed verbiage and not missing opportunities, was born.
When asked how it started, Sundem pointed to the data. In this case, a small facility, with just eight beds in West Virginia, was seeing exactly what was missing in a traditional NICU setting.
“Babies got better quicker, used less medication to help them [with] withdraw[al] and they had good outcomes,” says Sundem.
And so, the mission was simple. The data didn’t lie. Sundem decides: let’s bring it to Arizona.
First approached with the request to incorporate mothers into their plan, Sundem hesitated. She hadn’t cared for the moms before. It had always been about the infants, and Sundem was fairly certain that was the best way to approach it.
Her game plan changed though, when she looked into the Adverse Childhood Experiences (ACE) study, where adverse events that occur prior to age 18 significantly shape your risk for diabetes, heart disease, substance abuse, etc.
The ACE study is pretty significant when you consider things like life-course theory and long term health outcomes, as it moves away from the framework that health depends on just the presence or absence of illness.
I never imagined that it could be refocused to change care delivery though, and that’s exactly what Sundem and her team did. She started searching for funding, wanting to incorporate moms and eventually dads into their care plan, set up a building, and create a full-fledged program. And at first, like all nonprofit efforts, it wasn’t easy. In fact, they didn’t find anything.
Sundem played it by ear though, starting with one monthly talk to pregnant moms at a medication-assisted treatment clinic. Word got out. Suddenly, a pregnancy program was integrated, and the results were astounding.
“We had 85% of the moms that were active in that program keeping their babies and staying together,” shared Sundem.
Of course, we just had to know, what was the baseline? What’s that number like normally? To that, she responded, based on what she’s heard from her colleagues, that the number might be less than 50%. Anecdotally, some even estimated around 25%. This initial success is what led to finding a building, incorporating Kipu, and building the practice from the ground up.
These weren’t the only numbers that captured my attention, though. The average hospital stay for an NAS-diagnosed baby is 16 days, with extended stay sometimes averaging 21. Sundem wanted to decrease this. While 11-12 days was her initial goal with Hushabye, they’ve managed to hit an average of 6-7 days. Half of what she anticipated, and a significant decrease compared to the baseline.
Sure, this data, able to be organized and sourced through Kipu, has led to more funding, more expansion, and potential for growth, but it’s also done one other key thing. As someone with a keen interest in alternative forms of care delivery, it’s the perfect example.
By taking the standard approach and flipping it on its head, Hushabye Nursery has been able to improve outcomes, decrease net costs, and in general, approach NAS care more efficiently. Not only this, but their integrative approach has kept more families together, and will likely have more long-lasting effects on that baby’s growth and development than what treating them for 16 days in the hospital would have yielded.
It’s important. It’s revolutionary. It’s timely.
Deviating from the norm does not always mean success. Sometimes, you can work within the bounds of the system to get what you want done. Sometimes, though, it’s necessary. You can’t fix something that you haven’t even identified to be a problem. Hushabye Nursery, and by extension Tara Sundem and her team, saw the situation for what it is, and from my limited point of view, I must say that that was where their success started.
If you’d like to hear more from Tara Sundem and her story with Hushabye Nursery, you can find her live conversation with Kipu Client Success Manager, Lydia Pakpahan here. Learn more about Hushabye Nursery’s operational challenges and results with Kipu with their case study here.