SVMC Provides Safe Arms for Local Babies

Southwestern Vermont Medical Center's (SVMC) Women's and Children's Services (WCS) has a program meant to help newborns whose mothers are using Subutex to manage an opioid dependence (an addiction to opioid drugs including heroin and narcotic painkillers such as Oxycontin or Vicodin).

Called the Safe Arms Program,  the program began in June of 2010 and provides the mother-to-be, the baby's father, and their families with education and support for how to handle a newborn who may go through opioid withdrawal after birth.

"We are not here to judge," said Judy Trapp, registered nurse and clinical specialist in Women's and Children's Services. "Our goal is to support the new mother and her baby so they have the best possible outcomes before, during, and after birth."

The program also uses a Community Resource Team to help the new mother and infant. Members include the mother's obstetrician/midwife, a case manager, Vermont Department of Health (VDH), pediatricians, Division of Children and Families (DCF), lactation consultants, the mother's Subutex provider, and other area service providers such as Sunrise Family Resource Center and United Counseling Services.

Before the Safe Arms Program, babies born at SVMC to mothers on Subutex or other opioids were usually transported to Albany Medical Center after birth. This meant separating the mother from her child at a crucial time when she should be bonding with her infant.

Oftentimes, there was no education for the new mother on what to expect in this special circumstance after giving birth. She had no idea how to best help her child. As a result, both mother and child experienced additonal stress while the baby went through withdrawal.

"We saw a need in the community and felt we had to address it," added Trapp. "When a mother tells us early in her pregnancy that she is either in a Subutex program or she is buying drugs illegally, we can help her prepare for what lies ahead. If she isn't already in a program to help her with her dependency, her obstetrician or midwife can help get her into one. And we can help the baby right here in our community, where it is much easier for family and friends to support the whole family."

"The philosophy of patient care here at  SVMC will always be to keep the needs of the patient at the center of what we do," said Dr. Martin Luloff, chairman of SVMC's department of pediatrics. "The Safe Arms Program grew out of the Women's and Children's staff noticing that we had some patients who needed better support and greater coordination of care."

The process starts when a pregnant woman truthfully discusses her use of Subutex or other opioid with her provider. With communication open, the Safe Arms Program can begin to help the family. The mother-to-be signs a contract to participate in the program, agreeing to several provisions that are intended to optimize both her and her baby's health.

The program offers several key ways of helping, including:

  • The mother can more honestly discuss her needs for pain relief during childbirth and the team designs an individualized pain management plan for her.
  • The WCS staff gets to know the patient before delivery and offers education on what to expect after the baby is born; such as how he will act, what his cry will sound like, and how he will likely sleep and feed after birth.
  • The baby is kept at the hospital for at least 96 hours after birth. If the mother is discharged, the hospital continues to provide a room so the mother and baby can be together.
  • Every three to four hours, WCS staff rates how the baby is doing with a special rating scale. This helps WCS staff know how to best respond to the baby's medical needs and how they can help keep him more comfortable.
  • The mother agrees to take the baby to his pediatrician within the first week after birth.
  • A visiting nurse visits the newborn at home two times a week for six weeks after the baby has been discharged.

"Sometimes the mother-to-be is reluctant to tell her medical provider about her use of illegal substances," said Trapp, "for fear that DCF will be called in and her baby taken away from her. As health care providers, we are required to report this activity to DCF; but patients need to know that DCF's goal is to keep families together when possible. We all want to support and empower the mother and her family so they can best take care of their new baby."

From August 2011 to September 2012, the Safe Arms Program served 16 mothers. All of the infants were safely treated for withdrawal symptoms at SVMC, and none required transfer to another hospital because of their withdrawal.

"It has become clear that the collaboration between the medical staff (both obstetricians and pediatricians), nursing staff, and social service staff truly does insure that both the mother and infant are given the best possible care," stated Dr. Luloff. "I am proud of the way that all our departments are working together for our patients."

"Caring for our community's substance-dependent patients in our hospital is the right thing to do," said Trapp. "It is our goal to take care of people from this community in this community. Having the Safe Arms Program has allowed us to do just that, while ensuring the best possible outcome for both mother and child."