Figure 2. Principles of prioritizing prevention
• Tools to Promote Health: The principle of prioritizing prevention fo-
cuses on decreasing substance use in this population to promote the
health of women and children. For example, using a multidisciplinary
approach, women should have access to correct information about
the risks of substance use during pregnancy.
• Access to Treatment: The second principle focuses on ensuring that
pregnant women with substance use disorders have access to pre-
vention and treatment services. Their families will also benefit from
access to this information.
• Attention to Needs: The principle of respecting patient autonomy
focuses on the importance of respecting the mother’s decisions. RNs
should educate women in a patient-centered manner.
• Comprehensive Care: RNs must address various needs of breast-
feeding mothers and pregnant women with substance use disorders.
Interventions may be necessary to address needs like coexisting
medical issues or childcare.
• Relationships: The last principle encourages the development of re-
lationships between healthcare providers and patients that prevents
discrimination and stigmatization. For example, education should be
provided that accommodates a patient’s reading and comprehension
level.
Through care to pregnant women
and mothers abusing opioids and/
or other substances, RNs can
help prevent further substance
abuse. RNs can also improve the
health and well-being of chil-
dren affected by maternal opioid
abuse. By incorporating these
principles into nursing practice,
RNs can make a difference in
decreasing the effects of the epi-
demic on children.
NAS affects all socioeconomic
classes, races, and ethnicities.
Therefore, universal RN aware-
ness is critical to prevent children
from slipping through the health-
care system.
Issue 73, 1 2018 Pennsylvania Nurse 18
NAS occurs when a fetus is
exposed to certain substances in
utero. Presentation is due to the
sudden end of the substance sup-
ply through the placenta at birth
(National Alliance of Advocates
for Buprenorphine Treatment,
2016). In 2012, approximately
one baby with withdrawal symp-
toms was born every 25 minutes
(Lee, 2015).
RNs must be aware of the dif-
ference between addiction and
dependence. A newborn is born
physically dependent on the
substance(s) it was exposed to in
utero. However, the child is not
addicted. Addiction occurs due to
uncontrollable cravings and com-
pulsions. A newborn child does
not have cravings or compulsions.
Instead, the child is physically de-
pendent on the substance. Symp-
toms typically present in one to
three days. However, they can
take up to one week to begin. A
newborn’s withdrawal is the same
process as reported or observed in
adults.
Many substances can cause a new-
born to go through withdrawal
and experience NAS. Some sub-
stances, including street drugs,
are obvious. Other substances
are not as obvious. If a mother
is on a prescribed medication (for
example, methadone for drug
addiction), the baby will likely
withdrawal at birth (Stanford
Children’s Health, n.d.). In this
scenario, the mother’s treatment
in a controlled setting will offer
better support and outcomes than
a mother who is using unknown
street drugs.
Pain medications may also be
needed during pregnancy for
medical conditions (for example,
neurological). This type of
situation can also occur when a
mother needs antidepressants for
improved mental health through-
out pregnancy and postpartum.
Although newborns in these situ-
ations may have less withdrawal
effects, they still require monitor-
ing (Stanford Children’s Health,
n.d.).
RNs must be able to identify
substances that cause NAS. They
must also understand that some-
times NAS is unavoidable.
Treatment depends on the
substance used by the mother.
Medications, including antide-