Cuddling babies also soothing to volunteers
Infants provided with key physical contact and nurturing
Lourdes Zurita took the swaddled baby gently into her arms and sat in a chair next to the hospital bassinet. She gazed down at the infant, whose head rested in the crook of her right elbow.
Above the tiny bundle, white stitching on Zurita’s red shirt spelled out “Cuddle Club Volunteer.” A laminated cutout of an indigo koala hung from the bedside monitor, a signal that this baby was in need of special attention.
Zurita stroked the girl’s hair and caressed the blanket enveloping her, lightly placing an index finger on her nose.
On the third floor of Baptist Medical Center downtown, be- hind a set of light pink doors inscribed with the words “Mother Baby Unit,” a team of volunteers performs a simple, yet vital service: cuddling the infants in the neonatal intensive care unit.
The volunteers work with all the babies in the eight-bed ward, providing them with the physical contact and nurturing key to their development.
They are particularly attentive to the “koala babies,” as the nurses
and volunteers call them — the infants who are withdrawing from exposure to addictive drugs in the womb, a condition known as neonatal abstinence syndrome.
More babies with NAS are born in Bexar County than anywhere else in Texas, a trend that has persisted for almost a decade. The county had 288 such births in 2016, based on Medicaid data, accounting for more than a quarter of all babies in Texas born with NAS.
The use of the koala imagery comes from the idea that koala cubs need to be constantly cuddled to survive, said NICU nurse Lindy Ochoa, who coordinates the hospital’s cuddling program.
It also dovetails with the unit’s efforts not to stigmatize the babies or their parents. If the parents of other NICU babies ask what a koala sign means, nurses simply will say the baby “needs additional snuggling.”
“It was a way to make it more inviting for our NAS moms,” said Ginger Hejtmancik, a speech therapist who works with the babies on their feeding. “They’re already judged by everyone else. It was our way of making it more neutral but welcoming to every mother that comes in here.”
The baby in Zurita’s arms, Felicity Cuellar, was one such infant, still less than a week old. For the time being, the newborn was calm, mirroring the atmosphere of the room, where the lights were dimmed and the quiet was broken only by periodic beeps from machines and the murmurs of nurses at work.
Zurita could tell Felicity was comfortable based on her body language. She wasn’t crying or shaking, and she was not reacting negatively to Zurita’s touch.
Babies with NAS are prone to irritability and overstimulation, making the typical ways of calming an infant, such as by touch, overwhelming.
In those moments, the best thing to do is hold the baby tightly, and wait.
But that was not the case this day with Felicity. A postpartum nurse, January Rishell, walked over to check on her.
“Look, she’s completely knocked out,” she said.
Such contentment can be deceiving, Rishell said, because it is a different story as soon as they are put down.
Babies going through withdrawal can have problems coordinating bodily functions, like suckling, swallowing, breathing and regulating temperature. Some can develop “excessive suck” as a coping mechanism when they try to comfort themselves. Others, like Felicity, have a complete breakdown in their ability to suckle.
Every three hours, the babies are evaluated according to the Finnegan scoring system, a 21-point tool that takes into account the severity of a baby’s withdrawal symptoms as they affect the gastrointestinal, metabolic, blood vessel, respiratory and central nervous systems.
Felicity had problems with feeding, a common symptom, so a thin feeding tube snaked up her left nostril, held in place by a piece of tape. Hejtmancik had attempted to bottle-feed the baby before Zurita began holding her.
“Unfortunately, she didn’t do very well,” Rishell said, so she would receive the remainder of her formula through the tube.
“But that’s OK,” Rishell cooed to the baby as she began to prepare the formula. “You’ll get there. It’ll be fine.”
She filled a large syringe with formula and placed it in a pump that would gradually administer the food to the baby over the course of a half-hour, so as to avoid vomiting, another typical symptom.
Zurita had a serene expression on her face as she continued to hold the baby, swaying slowly in a wooden rocking chair.
Zurita, 53, applied to be a cuddling volunteer about a year ago. She wanted to be around babies while her own kids were away at college. Her niece worked in a NICU at another area hospital, so she knew how much care the infants needed, especially the koala babies.
The work is deeply rewarding but requires staunch patience. Zurita has handled other babies who were much more fussy and cried continuously in the high-pitched screams that are a hallmark of newborns with NAS.
A little more than a year ago, Ochoa, the nurse who oversees the volunteers, had been tasked with revamping the hospital’s cuddling program. Before, BMC only had four cuddlers who did not come in according to a regular schedule and received only limited training.
Ochoa redesigned the program, solicited applications from prospective volunteers and vetted them through phone and in-person interviews. Most had a personal reason for wanting to cuddle, and often, it was their desire to give back to the community. Cuddlers now undergo a detailed two-hour orientation, working one-on-one with Ochoa, before they start.
Since then, the cuddling program has burgeoned to about 20 volunteers, who come in for three-hour shifts from 6 a.m. to 9 p.m. Ochoa hopes to increase the number to 35 and have pairs of cuddlers working each shift.
Toward the end of Zurita’s shift on a Tuesday afternoon, another volunteer, Peggy Smith, arrived.
A licensed vocational nurse who works on clinical re- search in the oncology and hematology department at Brooke Army Medical Center, Smith, 58, sought out the cuddling program so she could work with the koala babies; her niece had been exposed to heroin before birth.
Smith picked up the baby in the bassinet adjacent to Felicity, where a koala also hung off the monitor. Earlier in the day, the baby girl had lain contentedly in a rocking seat that mimics the motions infants feel in utero, but it could not match human touch, so now Smith sat with her in another rocking chair.
Like Zurita, Smith feels she gets as much benefit as the babies do from the cuddling sessions, which she referred to as her “me time.” Once, after a hard day at work, Smith had walked into the unit and said to Ochoa, “Just hand me a baby.”
“As much as it soothes them, it soothes me,” Smith said.
Smith held the baby against her chest, resting her cheek against the top of the child’s head. In a low voice, she kept up a steady stream of commentary, telling the baby “yes ma’am” when she made a noise. She knew the infant could feel the chest vibrations as she spoke.
It was the same strategy Smith had used once with a far more upset little girl.
The baby had wailed for two hours, flailing her limbs and arching her back in distress. Smith talked and sang to the girl, staying an hour and a half past the end of her shift as she tried to calm her down. Finally, the infant locked eyes with Smith, released a deep sigh and “crumbled” into her chest.
This baby, though, seemed as calm as Felicity. Eventually, Smith handed off the infant to Rishell for a temperature check, bottle feeding and diaper change. It’s part of a “cluster care” approach that seeks to complete as many routine tasks at once so the baby is disturbed as infrequently as possible.
When the nurse went to burp the infant, she sat the baby upright and moved her midsection in a rhythmic circle called a “hula.” Rather than flopping back and forth, the baby’s head remained upright, her neck stiff, a sign of the abnormal muscle tone found in babies with NAS. While the baby continued to feed, she curled her fingers tightly around the bottle and Rishell’s hand.
Rishell placed her back in the bassinet and, apologizing, began changing her diaper as quickly as possible. The baby cried and thrashed about, her screams reaching a high pitch. As soon as she was swaddled and back in Rishell’s arms, she settled down.
Zurita, meanwhile, had been sitting with Felicity for two and a half hours. She stood and reached for the girl’s “koala cuddle log.” On the fourth line, she wrote the duration of their cuddling session, along with a note: “slept the whole time!”
Two days later, the volunteers and medical staff who worked in the NICU gathered in a classroom on the hospital’s third floor for a Thanksgiving potluck. A counter was crowded with food, a nearby table laden with gift bags for the cuddlers.
Dr. John Isaac, the NICU medical director, sat on the edge of a table with the volunteers in a semicircle in front of him. Isaac thanked them for their work and acknowledged how valuable they are.
Their efforts highlighted the “power of touch” and improved the culture of the unit, where staff may be under pressure, he said.
“When you have a calm cuddler, it rubs off on the baby for sure, and it rubs off on the people around,” he said.
Several volunteers said the benefits of cuddling are mutual, sometimes in profound ways. Edith Geurin described a “revelation” she had while holding a baby a few weeks ago: working with newborns was one of the few ways she could be close to God.
“This baby is all goodness, because its soul is so fresh, straight from heaven,” Geurin said. “And I feel the same way about death. When you’re with a person that dies, you’re close to God because that soul is going to God. And then I feel the same way with a newborn baby. I was just thinking, I am so blessed because I’m in this room, and I’m just surrounded by God’s goodness.”
“I am so blessed because I’m in this room, and I’m just surrounded by God’s goodness.”
Edith Geurin, volunteer cuddler
Cuddler Lourdes Zurita holds a baby in the neonatal intensive care unit at Baptist Medical Center. Some of these babies are going through withdrawal because of their moms’ drug use.
A baby suffering from withdrawal, known as neonatal abstinence syndrome, is weighed in the neonatal ICU.
Emily Nagayama, a registered nurse in the neonatal intensive care unit at Baptist Medical Center, administers morphine to a newborn suffering from neonatal abstinence syndrome. Morphine helps babies deal with the pain of withdrawal.
Lindy Ochoa, left, a nurse in the neonatal ICU for 37 years, hugs volunteer Agbeko Segbefia during a bimonthly appreciation dinner for the cuddlers.
Six-day-old Felicity Cuellar sleeps in the arms of cuddler Peggy Smith as Felicity’s father, Mark, takes a photo of her.