CONCORD (AP) — Judy Buckley held the tiny infant, just two-weeks old, close to her chest.

Swaddled in a pink-striped blanket, the baby girl let out a high-pitched cry. Buckley began to sing.

“We’re off to see the wizard,” Buckley cooed, as the baby whimpered. “The wonderful Wizard of Oz.”

“She’s so sweet,” she said, patting the little girl softly on the back. “You’re being so good,” she told her.

As a volunteer “cuddler,” Buckley’s job is to soothe some of Concord Hospital’s smallest, most vulnerable patients. The retired teacher spends hours holding and comforting babies, most of whom have neonatal abstinence syndrome, meaning they were born exposed to drugs in the womb.

Babies with NAS are essentially born in withdrawal – they suffer tremors, rashes, sleep deprivation and seizures, among other symptoms. Many of the symptoms mimic normal newborn behaviors: babies are fussy at times, they want to eat or be held. The difference is, with NAS babies, those symptoms don’t stop even after needs are met.

These babies need to be held for hours at times before they are able to rest.

As the opioid crisis has raged through the state, doctors have grappled with how to treat these tiny patients. Erin Collins, director of Concord Hospital’s The Family Place, said for a while the primary method used to treat babies with NAS was morphine.

However, in the last two years, Concord Hospital has turned to other methods of care: live music, reiki and human touch.

In May 2018, the hospital implemented its cuddlers program. Instead of medicating babies, volunteers swaddle the babies to calm them, and teach parents to do the same. The swaddle position mimics the comfort babies feel in the womb.

“I think we were all a little skeptical at first. How can we be in a health care society when everything is high technology, high acuity, and yet we’ve got almost the most simple of simplest care models that says, ‘Just hold them?'” Collins said. “How can that possibly work?

“But we’ve seen the clinical benefit – and it is more powerful than I can articulate.”

In the last 10 months, Concord Hospital has administered just a single dose of morphine to one baby out of the 61 infants born exposed to substances at The Family Place during that time period. Before the change in care model, one baby could receive 25 to 32 doses of morphine during their stay.

Up until the last decade, neonatal abstinence syndrome was not a term many medical professionals were familiar with.

Even 10 years ago, if doctors noticed a newborn crying erratically, they might have concluded that the baby’s mother smoked cigarettes during pregnancy, or took another prescription medication, like antidepressants.

Drugs like heroin and methamphetamines were not on newborn doctor radars – a drastic change from today, when each year in New Hampshire almost 500 babies are born having been exposed to opioids and other hard drugs.

Collins said clinicians were quicker at that time to administer morphine to babies if they knew they had been exposed to drugs in the womb – even if their symptoms weren’t severe.

Now, doctors ask simple questions before they decide how to proceed with the treatment of any baby, whether they were substance exposed or not: how well is the baby eating and sleeping and can he or she be consoled?

If they find a baby is in need of extra care, they will try reiki, live music of different kinds and cuddling before they resort to morphine, which they administer rarely, in small doses.

This has shortened hospital stays significantly, Collins said. Once a patient is started on morphine, they have to slowly be weaned off, which can take weeks.

In addition, evaluating each baby in the hospital by the same standards normalizes the process for the patient and doctors. Any baby who displays a need can have access to a cuddler, not just NAS babies.

“By presenting the program the way they do, it takes the bias out of it by making it available to all. It takes the stigma away from it for families who are already facing a lot of stigma,” said Joyce Johnson, a cuddler volunteer who also works at Concord Hospital in the Transport department.

The Cuddlers Program

Members of the Concord community expressed immediate interest in volunteering in the cuddlers program, said Annie Roy, a nurse at The Family Place who spearheaded the program.

“The response was just overwhelming,” she said.

Concord Hospital hosted a forum with the community to answer questions about the program and NAS and started an application process.

Staff soon had a waiting list for people who are interested. There is still a waiting list to become a cuddler at Concord Hospital.

Once accepted into the program, cuddlers go through a three-part orientation that helps them become familiar with the hospital, NAS and strategies of consoling babies.

Jessica Bailey, program manager for volunteer services at the hospital, said almost all of the cuddlers are women.

“They are women who have had children that know what it is like to take care of a child. Some of them don’t have their own children but have worked in childcare. Some of them have worked in substance use, so they have a connection that way,” Bailey said.

“Really, we’re just looking for a person that is compassionate, but also able to be non-judgmental,” Bailey added. “That’s always one of the big things that I talk with them about to make sure that they can come into the situation without judgment and know that they’re there for the baby and that’s their primary role.”

Cuddlers sign up using an online spreadsheet to be on call at some point 24 hours a day. Six volunteers can sign up for each slot, and they’ll be called as needed.

There are usually between one and five NAS babies at the hospital at one time.

Staff members have to find volunteers who are able to handle the demands of the job. Volunteers must be able to stay calm in high-stress situations.

“The babies can cause stress for people who are not used to caring for them,” Roy said. “They look disorganized to me. There’s this look in their face of fear. They can’t even be soothed enough to suck on their pacifier.”

“That’s something we evaluate in the volunteers. What’s their ability to really self-soothe?” Collins said. “When there’s a baby crying at a high-pitched cry, that gets anyone’s heart rate and blood pressure up. It takes a special someone and I think we’re fortunate in our program to have a lot of special someone’s.”

Buckley said she’s developed her own system over time for calming the babies she works with. There’s nothing more rewarding than watching a baby settle in your arms, Buckley said.

“There’s just a peacefulness that falls over them,” she said. “You can see the heart rate come down and they’ll look at you with their big eyes and yawn, and you know you’ve had a difference.”

“It’s powerful when you can see the heart rate come down right before your eyes,” she added.

When a baby is close to another person, it calms them by normalizing the respiratory rate, regulating the heart rate, and having a source of heat, said Buckley, who has three kids and three grandkids of her own.

Buckley and Johnson said families are incredibly grateful for the work of the cuddlers.

“We get thanked by people every day. I had mom thanking me just last week, saying, ‘I just really needed to sleep. Thank you so much,'” Johnson said. “It’s a way to help the family, who are already going through a lot.”

Buckley said one day a baby’s grandfather sat next to her while she was cuddling a baby.

“The grandfather came in and he said, ‘You’re a cuddler and that’s wonderful. You are a huge help.'” she said. “Right before he left, he just said, ‘thank you.'”

Collins said no one imagined that the cuddlers program would be as effective as it has been in its infancy.

“It’s really the power of healing in so many ways. For clinicians to resonate with a healing modality and not a high-tech approach can be hard,” she said. “Part of our role is to share the results with families, other organizations. There are still plenty of hospitals in New Hampshire, and the U.S., I’m sure, that haven’t quite made the shift to this care model.

“We’re just going to try to keep sharing our story, so that if something resonates with someone else, they can make that happen in their organization,” she added.

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