Mothers who use fentanyl, meth or other substances during their pregnancies can give birth to babies who have to spend weeks in the hospital to treat their exposure to and withdrawal from drugs. After their release, caregivers can still struggle to soothe and feed them.
Tricia Hughes, a registered nurse in Spokane, discovered this when she and her husband began fostering babies born dependent on heroin and other substances two decades ago. That experience inspired a 15-year-long quest to create Maddie’s Place, a nursery that provides around-the-clock care for drug-exposed babies. It opened in Spokane in October 2022, and is one of only a handful of such facilities in the nation that allows a parent in recovery to stay with their baby while receiving support services to care for themselves and their child.
Hughes is the founder and clinical director of Maddie’s Place. She joins us, along with Mary Potter, a mother in recovery who has been staying at Maddie’s Place with her five-month-old son. They share with us how the center is helping some of the youngest victims of the fentanyl crisis.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Mothers who use fentanyl, meth or other drugs during their pregnancies can give birth to babies who have to spend weeks in the hospital, but the challenges can linger long after that. This is what led a registered nurse in Spokane to create Maddie’s Place. It’s a nursery that provides around-the-clock care for drug-exposed babies. The facility opened in Spokane about a year and a half ago. It’s one of only a handful of places in the country that also allows a parent in recovery to stay at the same location. Tricia Hughes is the founder and clinical director of Maddie’s Place. She joins us now, along with Mary Potter, a mother in recovery who’s been staying at Maddie’s Place with her nearly five-month old son. Welcome to both of you.
Tricia Hughes: Thank you so much for having us and for calling attention to this issue.
Appreciate it.
Miller: Well, Tricia to start with, can you give us a sense for what the babies at Maddie’s Place are dealing with physically, especially when they arrive?
Hughes: Absolutely. I haven’t personally gone through withdrawal, but I have worked with adults in withdrawal at an inpatient facility and they describe it as feeling like their nerves are on fire and just like they want to crawl out of their skin. If you watch our babies, you can imagine that they’re feeling the same way. They tremor, they vomit a lot, they have diarrhea that eats their skin so they end up with really raw and sore diaper rashes. A lot of them struggle to eat. They can’t coordinate their swallowing and breathing. They start losing weight. A lot of them end up with a tube in their nose to their stomach to give them enough calories because at the same time, they’re burning a lot of calories with their physical reaction to withdrawal. They tend to be hypertonic so very tight and all pulled in, kind of grasping at themselves sometimes and pinching their own skin, or hypotonic where they’re just kind of limp and checked out. They can’t tolerate light often. They can’t look at you and they can’t make eye contact. It’s just too overstimulating for their brain. They don’t tolerate noise and sometimes not even touch very well.
Miller: It’s overwhelming. Everything you just described is really hard to hear and it seems like an overwhelming medical challenge. I’m wondering how the care that you can provide for babies recovering from prenatal drug exposure at your facility is different from what they might get at a hospital NICU (Neonatal Intensive Care Unit)?
Hughes: Yeah, we have created an environment here that is very home-like. The common area feels like a living room and it’s outfitted like a living room. And then we have dim lights, quiet. Everything about the design of the space that the babies are in was intentional, from not having a bathroom off the main area so that a door wouldn’t be opening and closing all the time, to nothing that beeps out loud. Our fire alarms are set to flash only in the nursery spaces. Every single detail in those spaces was designed to keep it low stimulations, that we aren’t overwhelming these babies who are already overwhelmed by their bodies.
So, we’ve created this quiet, dimly lit, comfortable space with a lot of staff and I’ve specifically trained all our staff in how to handle our babies based on research and experience together, so that we don’t cause more overstimulation. And we recognize when they are not doing well and we can actually go into their room and shut the door. If we need to remove even more stimuli from their environment, we can. So what that results in is a lower need for medication in the hospitals. This kind of reaction is often treated with morphine. And when the baby is not withdrawing from opiates, morphine isn’t going to help. So if it’s not fentanyl or any other opiate, it’s just methamphetamine, cocaine, we’re seeing more of that, then they honestly don’t get anything from the hospitals, just maybe some feeding support which we can absolutely do here.
Our environment coupled with the amount of staff that we have and the way that we are trained to only handle babies who are in withdrawal, creates just a pretty great space for them to withdraw, but be supported and every cry attended to, which is so important for attachment at the most early days and weeks.
Miller: If you took in a baby at this point without any information about them–a circumstance I hope it would never happen–but I’m just curious, and you didn’t say have a tox screen to know what was in their system, do you think at this point you’d be able to tell what drugs they had been exposed to?
Hughes: It’s likely. You definitely see different reactions from opiates as compared to stimulants, but there’s so many other things that are often used in combination including marijuana, alcohol, nicotine, even SSRIs (selective serotonin reuptake inhibitors). Common antidepressants can cause and also exacerbate some withdrawal symptoms. So we wouldn’t know exactly. I used to think that it was really important to know exactly what they were exposed to so that we could handle them exactly the right way, but there are so many influences on how the baby is going to respond. I always say to my staff, be an expert on the baby before you. So what we would do is watch that baby, attend to them. Obviously, we’re 24-hour care and so we adapt our care based on what the baby is showing us they need from us.
Miller: Mary Potter, I want to turn to you. I understand you’ve been at Maddie’s Place with your son since October. How old was he when you arrived?
Potter: He was a little over a month when we arrived here.
Miller: How did you hear about Maddie’s Place?
Potter: I heard about Maddie’s Place from Sacred Heart because my son was there in the NICU.
Miller: What were his early weeks like?
Potter: In the NICU?
Miller: In the NICU when he was born?
Potter: Well, we were in Moses Lake. He was born in Moses Lake, Washington and we had a rough birth. So he had to get life flighted to a Sacred Heart. And when he was there, I was on methadone, so he had methadone in his system. So they had him on morphine and Klonopin. And so he was hard to console, I guess. He just seemed to always get so upset and he wouldn’t eat. He had a feeding tube. So, yeah, I don’t know what else to say.
Miller: And where were you? And what was going on in your life in those weeks after he was born, when he was still at the NICU at the hospital?
Potter: I was staying at Ronald McDonald House, which is a place for families when their babies are in the NICU and I would go visit him like every time he would eat. Normally, when they’re in the hospital, they’ll pick him up to feed them, change their diaper and then they put them back down so they can sleep. So they would let me come in and do his cares, like change his diaper, feed him and then they didn’t want me to hold him. They just wanted him to be able to get a good sleep like laying down in the crib…or you holding him for like several hours and not putting him down. But I was visiting him for like multiple times a day just so he could get used to me being there.
Miller: And then at a certain point, he was ready to leave the NICU and you made the decision to go to Maddie’s Place. Why?
Potter: Because they told me about Maddie’s Place and said I would be a perfect fit for Maddie’s Place. I went because I had nowhere else to go. Because Zachariah was still on the feeding tube and if I would have taken him home to Ephrata, I wouldn’t have been very confident about it because I didn’t really know how to do it. So he would probably start losing weight or something would have happened. So we decided to go to Maddie’s Place because they had staff there that knew how to do the feeding tube and could help me take care of Zachariah, because this is all new to me [and] because my two daughters that I had got taken away at birth. So I never got to raise them because I was on drugs. But this is all new to me. So this is a perfect place for me so I can get help with knowing how to take care of Zachariah or knowing what to do for him, you know?
Miller: Just so I understand, you had two children before? But both of them were taken away as soon as they were born by the state because you were still actively using drugs?
Potter: Yes. Correct.
Miller: Did you know how to change a diaper before Zachariah, your baby, was born?
Potter: No, but when I was in the NICU I would just watch what the nurse would do and then at first, I was very slow at it (laughter) but now that I’ve been here at Maggie’s place and I’m doing it over and over and over again, I’ve gotten really fast at it.
Miller: What do you think was different for you about this pregnancy or this birth and the two before? If I understand correctly, you were already on methadone when Zachariah, your son, was born. What was different this time?
Potter: I think that what was different this time is that God gave me another chance to have another baby. So I just told myself that I’m going to do whatever it takes in order to keep him no matter what, how hard, no matter whatever I have to do in order to be his mom, I will do [it]. So that’s what I did. I just went to treatment and have stayed sober since. I have 11 months, clean and sober. So I just don’t know, I just figured that God gave me another chance to have another kid, so I will be there for him no matter what.
Miller: Tricia, how common is it for people who are pregnant to get methadone?
Hughes: Well, it’s less common than we would like, but also problematic. So, first of all, Mary, I just want to say, I wish you could see my face when you were talking about that. I’m just beaming with pride. I am so proud of you and so grateful for the opportunity to watch you grow. It’s been amazing.
Potter: Thank you.
Hughes: So methadone is a manufactured drug, an FDA-approved drug, used to treat opiate addiction. It’s a full opiate. So it acts just like heroin on opiate receptors in the body. So while it serves the purpose of helping moms avoid fentanyl or whatever opiates they can get on the streets, unfortunately, babies still withdraw quite severely from methadone. It’s manufactured so it’s a little bit different from heroin and it has a very long half life, which means that it stays around in the baby’s body for a very long time.
So honestly, some of the hardest withdrawals we see for our babies are from methadone and Subutex, which is another medication that is used for opiate addiction treatment. And that fact is not well communicated to moms, unfortunately. I don’t think Mary had any idea to expect some withdrawal from her son. She was doing the right thing, she went to treatment while she was pregnant, which is not easy to find. There are, I think, two places in our state that will do that, and actually take a mom, a pregnant woman from opiates to medication-assisted treatment with methadone or Subutex. Only two in our whole state. And then they’re not really prepared for what their babies will experience when they’re born.
It’s great that they’re getting treatment, there’s not enough of it available. It’s also unfortunate that they’re not prepared for the birth and what their baby will experience when they’re born.
Miller: Tricia, I mentioned in my intro that I’ve learned that, first of all, it’s not particularly common for there to be centers like yours that do this exact work, nurseries that focus on babies who are born with drugs in their system and to focus on the very specific needs of this population. But it’s even more rare for these centers to also take in parents in the way that you do. Why? What’s the thinking behind it?
Hughes: Well, I’m not really sure, honestly. I know that the nurseries that are operating, all of us struggle for funding. Exposed babies have historically been treated in the NICU and then just sent by their home with grandparents, into foster care, wherever. And then unfortunately, the latent phase of withdrawal for a baby is six to eight months. And the neonatologist and staff that care for babies in the hospitals don’t get to see these babies on the other side. So there’s a lack of awareness of the experience of these babies, the rates of readmission to the hospital, the risk of failure to thrive, unfortunately non-accidental trauma, a lot of complications and risk to the babies after they’re treated at the hospital and discharged. There’s been a lack of recognition and willingness to support this kind of care from Medicaid, quite honestly.
So we’re all struggling for funding, struggling for kind of recognition for what we do. And on top of that, there’s very poor data on how many of these babies are actually born every year in the whole country. No state has good data on the amount of babies that are born needing our care. So that makes it even harder to prove our case that we’re needed.
Miller: Mary, from your own experience–people you know, people you’ve heard about–do you have a sense for how common it is for babies to be born to mothers who are actively using meth or fentanyl or other drugs?
Potter: Yes, it’s very common for babies to be born drug addicted. That’s what I think because a lot of people in Moses Lake, they get their babies taken away because they’re born addicted to drugs. And over there there’s nothing, there’s no treatments, there’s nothing over there. So half the time, people just end up losing or signing their rights over.
Miller: As you noted, that is what happened to you twice.
Potter: Yes. Correct.
Miller: Tricia, you mentioned that there is a major gap in data right now. My understanding is a team of researchers from Washington State University are going to be spending a year studying your center. What exactly will they be studying? And what are you hoping will come from that?
Hughes: We are hoping…really our biggest goal is to just show the numbers. For example, the CDC states that the percentage of drug-affected newborns equates to 36 babies a year in the Spokane area, according to our birth rate here. Well, we admitted almost 60 babies last year and we know that we weren’t getting even a fraction of the babies that were born that could have used our care. So it’s just largely out of touch with what’s really going on and we’re hopeful that WSU will be able to shine some light on that.
They’re going to be looking at our outcomes, but on a very high level because the study has been somewhat truncated due to contract issues with the health care authority in the state of Washington so we’re just planning to dump as much data as we can to them. We’re not really sure how much they’ll be able to put in a meaningful sort of presentation, but our hope is that they’re able to show that this kind of care results in more families together, more babies able to attach and connect as that’s a huge issue with our population of babies and just shining a light on the incidents, the number of babies that are actually experiencing this.
Miller: Tricia, my understanding is that the name Maddie’s Place came from a baby that you took in as a foster child a number of years ago now. She herself was drug exposed. How is she doing today?
Hughes: Yeah, she’s 15. I will say I have five adopted children who were all exposed prenatally and she is the most emotionally intelligent of all of them. She’s the baby we received at the youngest age. So she was 16-days old when she came to our house, but she was in terrible opiate withdrawal as her mom had continued to use all the way up to birth and then lived on the streets of Spokane for the first 16 days of her life. So she was just honestly a hot mess when we received her. And I was told that mom didn’t use it during their pregnancy so I had to figure out what was going on and convince the social worker to demand mom to find out what she was using.
In the process of caring for her, I missed a lot of life that first year with her. She would only sleep in a Moby Wrap on my chest. If I was in an environment that got above a quiet din, she would just absolutely spin out, start screaming and tremoring and we had to tuck her back in the Moby and leave. So I learned by just figuring it out how to care for her, but she was my eighth child and I’d been a labor and delivery nurse and attended at least 300 births by that point in my life. I had a lot of experience to draw on and a lot of medical knowledge to pull into it, a lot of resources and connections and I just figured it out. But I realized that not everyone who’s raising these babies has that. And I just had this burning desire. She sort of lit this fire in me to spread this information and help people and help these babies so that we address these early days and weeks with them.
The first 60 days of life are just absolutely foundational for our relationship and development for our babies. And if they are in pain and their brains and their bodies are on fire, we are not setting a very good foundation for them. So I’m just passionate about that now, and Maddie’s doing great. She struggles in school a little bit, but that’s to be expected, honestly. She’s just sweet and kind and there’s not a person who knows or who wouldn’t say that about her.
Miller: Mary Potter, we just have less than a minute left, but what are your hopes for your son’s life?
Potter: To have a mom that can take care of him and for him to not use drugs or struggle with anything.
Miller: Mary Potter and Tricia Hughes, thanks very much.
Hughes: Thank you.
Potter: Thank you so much
Miller: Tricia Hughes is a registered nurse, the founder and clinical director of Maddie’s Place in Spokane. Mary Potter is a mother in recovery, staying at Maddie’s Place along with her five-month old son.
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