Jen

Just wanted to share my experience with adoptions, babies in NICU, and
methadone withdrawl.  There are several issues here.  As far as donor EBM,
it will be up to the neonatologist/pediatrician caring for the baby to order
it.   And many, many NICU's do not use donor milk.  The OB has nothing to do
with the decision, but he may know if it is a standard or even accepted
practice in the NICU.  He/she may be willing to inquire for the adoptive mom
or at least put her in touch with the Clinical Manager to work through
this.  If it is not standard, they may be willing to use donor milk - as
long as the adoptive parents will absorb the cost.  Although with the
prematurity and withdrawl I think insurance would cover it.  Now - the next
issue: adoptive parents  At our facility, we wouldn't even talk to an
adoptive mom or have them be determining any medical/parental care until the
birth mother has signed her paperwork relinquishing her rights to the baby -
typically 24-48 hrs after delivery.  Then a judge will award custody of the
baby to the agency involved or the adoptive parents.  The agency social
worker or attorney can explain how it works in your state.   Adoptive
parents are no different than any visitor/support person of the birth mom
and her baby and we don't openly share info with any visitor, correct?
There are major confidentiality issues here.  And it is HER baby until she
signs documents otherwise.  She can change her mind - and I have seen what
look like very congenial relationships fall apart on a dime.  The adoptive
parents can be there all day holding the baby and then go out to lunch and
the birth mom will tell her nurse - "Don't let them come back in here.  I've
changed my mind."  It happens alot more than what people might think.  Now
in this situation, this mom is on methadone - their will be CPS involved
-and even if she does change her mind, the baby will be made what we call a
CHINS (Child in Need of Services) - techically a ward of the court as they
sort through everything.  All the social workers will be VERY supportive and
encouraging of her decision to adopt out.  As far as Methadone withdrawl,
our babies are placed on high calorie formula (24cal) because they need the
extra calories as their metabolism is reved up.  They have a lot of gut
issues because of the withdrawl.  We tend to use Lactose free formula.
Donor milk would be a good thing for the gut issues - and that would be the
tactic I would recommend for the adoptive parents in talking with Clinical
Manager and physicians. They would fortify it because of the prematurity and
the withdrawl.  Our term newborns are weaned off their mom's medications
very slowly.  We typically treat with morphine elixir.  Usually takes at
least 4 weeks for a full term baby and we do not send babies home until they
are totally off their meds.  And this baby is pre-term with all the issues
that involves.  Encourage them to take it one day at time -it's going to be
a long haul.  God bless this family!

--
Sheryl Ward, RNC, BSN, IBCLC
Greenwood, IN
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