Cud­dling ba­bies also sooth­ing to vol­un­teers

In­fants pro­vided with key phys­i­cal con­tact and nur­tur­ing

San Antonio Express-News (Sunday) - - Front Page - By Lau­ren Caruba STAFF WRITER

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

Pho­tos by Matthew Busch / Con­trib­u­tor

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.

Pho­tos by Matthew Busch / Con­trib­u­tor

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.

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