The rate of opioid use among women in state prisons and jails is estimated at 20 percent.[1] A 2019 study[2] examining admissions of pregnant adults of 13 state prisons found that in July of 2016, 3.9 percent (65 of 1,646) of the women admitted were pregnant, and a similar rate was observed in December of the same year. Recent years have shown an increase in the incarceration rate among women, as indicated by the Bureau of Justice Statistics’ 2021 Jail Inmate Statistical Tables, which reported a 22 percent increase from 2020 to 2021. These rising numbers may contribute to a concerning consequence: babies born with opioid withdrawal symptoms to a parent involved with the criminal justice system.

Neonatal abstinence syndrome (NAS) is the clinical term for the symptoms experienced by infants born to mothers who use opioids during pregnancy. NAS is often characterized by a complex and uncomfortable withdrawal syndrome that includes difficulty feeding, irritability, excessive crying, and poor sleep. Historically, treatment for NAS has taken place in a hospital setting, where babies with NAS are given medication, often morphine, and separated from their parents for long periods.[3] But there is an alternative to this model. Hushabye Nursery is an innovative program in Phoenix, Arizona, that provides short-term therapeutic medical care and additional social and behavioral health services for infants with NAS and their caregivers.

“In order to truly serve a baby with NAS, we need to serve the whole family,” says Tara Sundem, a neonatal nurse practitioner and the co-founder and executive director of Hushabye. “So that’s what we do—Hushabye offers compassionate, trauma-informed, and integrative care to babies and their families from pregnancy through the postpartum period and beyond.”

Safe and Effective Alternative to Hospital Care

At Hushabye Nursery, infants and their caregivers share a private room where parents can fully participate in helping their newborns get well. “The research shows that comforting techniques can be as or more effective than pharmacological treatment,” says Sundem. “As soon as parents and their babies walk in our doors, we can put the baby in the parent’s arms, dim the lights, and begin the bonding and soothing process.” This approach, known as “Eat, Sleep, Console,” can reduce the need for opioid medication treatment in babies and the length of a medical stay by as much as 79 percent.

“The hospital is not always the most trauma-informed or welcoming environment for a mother with opioid use disorder (OUD),” says Sundem. “Usually, these moms and dads want to parent successfully. We offer them a judgment-free environment to bond with their babies and get the support they need to keep their family together.”

Hushabye Nursery is staffed by clinicians (nurse practitioners and registered nurses), therapists, social workers, case workers, peers, and other supports focused on helping families heal together and setting them on a path for continued success. Most babies treated at Hushabye are transferred from the hospital right after birth as long as they are medically healthy enough to do so. While the average length of stay in the hospital for NAS is 21 days, Hushabye’s average is 8 days.

Community Corrections Collaboration

Hushabye Nursery collaborates with the Arizona Department of Child Safety to help families meet the requirements to maintain or regain custody of their infants or older children. A key to Hushabye’s success in serving families is its connections across the community and system of care, which helps ensure that all a family’s needs and concerns are met.

Hushabye works closely with medication-assisted treatment (MAT) providers who serve both moms and partners. They also have behavioral health providers on staff and several substance use disorder (SUD) support groups, including SMART Recovery. Additionally, Hushabye case managers connect families with additional supports such as housing, SNAP, WIC, and other services.

Furthermore, Hushabye Nursery works with a local nonprofit, The Bail Project, which provides financial support for pregnant or new moms who are out on bail, enabling them to engage with Hushabye’s services. This way, they can give birth or parent their babies in a safe environment outside of carceral settings while awaiting trial. Hushabye also assists the people in their program with their legal needs through partnerships with The Bail Project, the First Steps Program with Pinal County Superior Court, and the Family Treatment Court in Maricopa County.

Prenatal and Postpartum Family Supports and Services

Hushabye Nursery provides prenatal through postpartum services for pregnant and parenting families who struggle with SUD or OUD. The nursery is just one of many supports Hushabye has for families.

Parents can attend prenatal and postpartum educational and training classes about SUDs and baby care; receive peer support from families who have been through the experience of OUD and caring for a baby with NAS; attend one of many virtual and in-person support groups; and shop for baby supplies at Hushabye’s free store, using “Hush Money”—credits earned for participating in these activities.

Hushabye welcomes women and their partners into their program at any stage of their recovery journey, whether they are still pregnant or after the baby is born. The only requirement for accessing services is having an OUD and a desire to be involved. “We have moms join us who have been on MAT for years and those who are still on their first day of sobriety,” says Sundem. “We meet them where they are and work with them to help get baby and themselves well.”

These activities empower local families. “One of the greatest things we offer parents is hope,” says Sundem. “Whether it is through meeting a peer, going to a support group, or staying with us with their baby, we give parents the space to have their ‘aha moment’ where they begin to believe that they are what is best for their babies. It’s a beautiful thing to see.”

References

[1] Bronson, Jennifer, Jessica Stroop, Stephanie Zimmer, and Marcus Berzofsky. “Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007–2009.” Washington, DC: United States Department of Justice, Office of Juvenile Justice and Delinquency Prevention (2017).

[2] Sufrin, Carolyn, Lauren Beal, Jennifer Clarke, Rachel Jones, and William D. Mosher. “Pregnancy Outcomes in US Prisons, 2016–2017.” American Journal of Public Health 109, no. 5 (2019): 799-805. https://doi.org/10.2105/AJPH.2019.305006

[3] Byerley, Eva M., Mohamed W. Mohamed, Carlina J. Grindeland, and Julia D. Muzzy Williamson. “Neonatal Abstinence Syndrome Practices in the United States.” The Journal of Pediatric Pharmacology and Therapeutics, 26, no. 6(2020): 577-583. https://doi.org/10.5863/1551-6776-26.6.577.

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