Jenna Richard

NUR 4143

March 4, 2017

Midterm Reflection

Throughout my time spent in the NICU at St Francis Medical Center, I have experienced

many moments that were challenging and allowed me to grow as a nurse and as a person. One

patient comes to mind when I think of the most challenging moment so far in my clinical

immersion. It was not that the patient himself was challenging or required complex care, but

rather the social aspect was difficult to wrap my head around. The baby was withdrawing

because his mother had been using heroin, smoking cigarettes, and drinking alcohol throughout

her pregnancy. On top of that, he was born with a congenital heart defect- tetralogy of fallot.

After a long stay in the NICU receiving morphine and then being weaned from it, it was time to

go home. However, it was not such a happy time as it usually is seeing a baby go home. We were

worried about this babys future and whether he would receive the proper care he needed.

We were sure to do everything in our power to make sure the baby had the best life

possible after leaving the hospital. We taught the parents and the babys older sister over and

over about proper care and precautions for caring for a newborn. Child protective services chose

not to take the child from the parents, even though the father of the child was also a registered

sex offender and had not one, but two ankle monitors on. This is one thing that I wish would

have gone differently- that CPS would have taken measures to ensure the safety of the child

rather than just turning the other cheek. But this was out of our hands, and the child eventually

did go home with his parents.

 The clinical judgment that we made was based on the history of the mothers drug abuse

and the fathers criminal record. We did our best to take this as an opportunity to educate the

family and hope that they could change in order to provide the best life possible for their new

baby. We also worked to promote bonding between the parents and child and encouraged the

family to visit as often as possible to help with the babys recovery.

After talking with the mother for some time, we learned that she had been on an

extremely high dose of methadone near the end of her pregnancy and was still taking it daily. She

was told by the staff at the methadone clinic that most babies never even experienced withdrawal

symptoms. This is completely untrue, in fact, an article from BMJ Case Reports says that 48-

94% of infants exposed to methadone or heroin in utero experienced Neonatal Abstinence

Syndrome (NAS). The article also mentions the difficulty of determining the prevalence of

heroin use in pregnancy due to the mothers feelings of guilt, fear of social services involvement,

and denial. Many times, we do not know that the mother has been using until the babies starts

showing signs of withdrawal.

Babies suffering from NAS are commonly seen in the NICU at St Francis and I have

already cared for five of these babies in my short time on the unit. It is incredibly sad and

frustrating to see these innocent babies suffer and it is even harder to see them go to a broken

home. The most important thing that we can do as nurses to prevent future occurrences like this

is to educate and make sure that the mothers are receiving proper prenatal care. With the

growing heroin epidemic, it is more important than ever to be sure that pregnant women are

aware of the dangers of opioid use in pregnancy.

 References

Namboodiri, V., George, S., Boulay, S., & Fair, M. (2010). Pregnant heroin addict: what about

the baby? BMJ Case Reports, 2010, bcr09.2009.2246.

http://doi.org/10.1136/bcr.09.2009.2246