Alicia Nelson is a National Health Corps Florida AmeriCorps member serving as a case manager at River Region Human Services. She shares her experience with babies with Neonatal Abstinence Syndrome and their moms.
My name is Alicia Nelson and I’m currently completing my service term with the National Health Corps Florida, an AmeriCorps program based out of the Northeast Florida Healthy Start Coalition. So far, I have served over 1,500 hours at River Region Human Services, which provides treatment for individuals and families affected by substance abuse.
Already this year, I have personally met over 50 babies with Neonatal Abstinence Syndrome, either through teaching classes at River Region’s outpatient treatment program, providing case management at our inpatient residential facility or as a volunteer Infant Cuddler at UF Health Jacksonville. I have also formed relationships with their mothers who are at various stages of recovery.
Through these relationships, I have seen how difficult it is to manage a high-risk pregnancy, even more so when these mothers encounter friends, families and even medical professionals who consider their addiction to be a moral failure. During my service term, I have been asked many times, “How do we punish the mothers of these babies for what they did?” I am less often asked, “What can we do for the babies born addicted to help them grow into healthy adults?” I am proud of my fellow National Health Corps members and our community partners who are asking and answering this second question.
I’ve seen firsthand that prioritizing the health of the baby goes hand-in-hand with treating the mother with compassion. Providing this kind of care and support goes a long way in improving the health of mothers, infants and reducing the burden of addiction in our community as a whole.
Infant mortality in Northeast Florida increased in 2016, after a decline in 2015. In 2016, 139 babies died before their first birthday, the equivalent of eight classes of kindergarteners. With a rate of 7.9 deaths per 1000 live births, the region remains higher than the state (6.1 deaths) and nation (5.8 deaths).
Duval County, the population center of the region, continues to drive the region’s infant mortality rate with 8.4 deaths per 1000 live births. Counties with smaller populations like Baker, Clay and St. Johns saw fluctuations from year-to-year, as a few additional or less deaths impact the rate much more than larger counties.
Black babies are still dying at more than twice the rate of white babies. Black moms are nearly 2.5 times as likely to experience an infant death as white moms (11.9 deaths per 1000 live births,
compared to 4.9 deaths). This trend has been consistent over the past five years. National trends show that racial disparities persist despite education level or socioeconomic status.
One in five deaths was due to Sudden Unexpected Infants Deaths (SUIDs) in 2016, most of which were sleep-related. SUIDs declined significantly in the 1990s and 2000s in part due to new recommendations from the American Academy of Pediatrics and the nationwide Back to Sleep campaign, but have steadily increased since 2012 (up 42 percent in Northeast Florida). These deaths are largely preventable, and are taking up a bigger proportion of infant deaths.
Bedsharing is a leading factor identified in sleep-related deaths. Causes of death and contributing factors include:
- Suffocation and strangulation (often associated with bedsharing)
- Unsafe sleep environments (adult bed, couch or chair, soft items like bedding, blankets and stuffed animals)
- Position (stomach instead of back)
As the opioid epidemic explodes across the region, state and nation, there has been a dramatic rise in the rate of substance-exposed newborns. Data from 2016 shows that more than 700 babies with NAS were born in facilities in Northeast Florida. Three counties in Northeast Florida (Baker, Clay and Duval) were listed in the top 10 counties in the state for substance-exposed newborns, according to a March 2015 report from the Florida Department of Health.
Babies diagnosed with Neonatal Abstinence Syndrome are primarily born to moms who were addicted to opioids and more likely to be born premature and low birthweight. NAS babies also experience irritability, breathing and feeding problems, in addition to a myriad of lifelong issues that often are not realized until the child is older.
The Northeast Florida Healthy Start Coalition was awarded a three-year grant from the U.S Department of Health and Human Services Office on Women’s Health (HHS OWH) to reduce the alarming rate of babies born with Neonatal Abstinence Syndrome (NAS), a condition experienced by neonates exposed to opioid prescription or illicit drugs during the prenatal period. The grant will be managed by a prevention director at the Azalea Project, an initiative of the Coalition focused on substance-misusing women.
With this new grant, the Coalition will provide primary prevention education workshops to health
consumers and health providers in Baker, Clay, Duval, Nassau and St. Johns counties on topics such as recognizing the signs of substance abuse, resource education, an overview of the opioid epidemic and proper disposal of prescription drugs. High-risk consumer groups will be targeted, including women with a history of domestic violence, adults who didn’t finish high school, faith-based organizations and college-aged young adults. Additionally, health care providers and their staff will be trained on Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence-based tool that aims to increase the screening of women for substance use prior to pregnancy
The Coalition will also establish a new partnership with Lutheran Services Florida (LSF) Health Systems to train a cohort of 60 peers (20 per grant year) as Certified Recovery Peer Specialists.
According to the Centers for Disease Control and Prevention, between 2002 and 2013, heroin use among women increased by 100 percent nationally. A March 2015 report released by the Florida Department of Health shows that Northeast Florida has high rates of infants born with NAS. Nassau (#5), Baker (#7) and Clay (#10) counties all ranked in the top 10 counties with the highest rates in the state, 145-187 percent higher than the state rate. Duval County has the highest number of babies born with NAS than any other county at 450 babies.
The Coalition, which has a long history of addressing substance use in women, was one of 16 projects selected for funding across the country. In 2003, the Coalition launched the Azalea Project in a storefront in Jacksonville’s Springfield neighborhood to reduce risk-taking behavior in substance abusing pregnant and parenting women. The project works to break the cycle of substance use and other at-risk behaviors by providing outreach and intensive case management services. The OWH grant will allow Azalea to expand into primary prevention and support the efforts of the Coalition’s Substance-exposed Newborn Task Force.
As World Breastfeeding Week (WBW) 2017 comes to an end, the Northeast Florida Healthy Start Coalition supports the recommendations of the American Academy of Pediatrics (AAP) and other organizations that babies should be breastfed exclusively for six months and continue breastfeeding for the first year of life and beyond.
World Breastfeeding Week is organized by the World Alliance for Breastfeeding Action. The WBW 2017 theme was Sustaining Breastfeeding Together. While breastfeeding can sometimes be a challenge, mothers can be successful with support and encouragement. Coalition Breastfeeding Outreach Coordinator Denise Mills, provides breastfeeding classes in the community and encourages mothers to set goals each month and try to reach them. The next month they should set new goals and grow from there.
Both baby and mother gain many benefits from breast feeding, according to the Centers for Disease Control and Prevention (CDC). Breastmilk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections. A baby’s risk of becoming an overweight child declines with each month of breastfeeding. Women who breastfeed may have lower rates of ovarian cancer and certain types of breast cancer. It also allows mother more time to bond with baby.
Mothers may experience latch issues, engorgement or concerns about your milk output concerns. Mothers can find support and resources at their delivering hospital, their local WIC office, the La Leche League — Northeast Florida, the National Breastfeeding Helpline at 1.800.994.9662 and online resources like whattoexpect.com and kellymom.com. For mothers living in Northeast Florida, the Coalition hosts weekly community breastfeeding support groups at several locations throughout Jacksonville:
- Tuesdays from 11:30 am until 1:00 pm at the Azalea Project
- Wednesdays at UF Health from 1:00 pm until 2:00 pm
Denise Mills can be reached at DMills@nefhsc.org or 904.723.5422 x 127
The Coalition hosted a safe sleep training for home visitors and health care professionals to explore causes of sleep-related deaths on July 26. The training included a presentation by Dr. Emmanuel Peña, UF College of Medicine Jacksonville Assistant Professor & Child Abuse Pediatrician.
One hundred attendees from the Coalition, Jewish Family and Community Services, Children’s Home Society, the Jacksonville Children’s Commission, Family Support Services of North Florida, THE PLAYERS Center for Child Health and Baptist Health attended the training.
The presentation delved into the history of Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Deaths (SUIDs) and how unsafe sleep practices are causing babies to die. Dr. Peña also discussed the importance of applying safe sleep recommendations to individual family situations and the need for changes in the SUID death scene investigations and autopsies.
The training ended with a Q&A where the participants were able to ask Dr. Emmanuel Peña specific questions pertaining to situations that they have experienced.