Eat. Sleep. Console.

Three simple words that describe a patient-centred, culturally safe, and trauma-informed approach to improving care for newborns with Neonatal Abstinence Syndrome (NAS) and their families.

According to Perinatal Services BC, the incidence rate of NAS in BC has risen significantly since 2010. This increase, along with the urgent need for culturally safe care as outlined in the In Plain Sight report, make this initiative more relevant than ever.

Eat Sleep Console (ESC) aims to give women and newborns impacted by perinatal substance use the best start possible.

Mom and baby togetherness

When newborns are exposed to substances such as opioids before birth, they may experience NAS as they withdraw from those substances. Symptoms include challenges with sleeping, feeding, and being comforted.

Traditionally, babies with NAS are separated from their mothers and placed in neonatal intensive care unit settings to receive care. Treatment for NAS typically has a more pharmacological approach that centres on medication, such as morphine.

“With Eat Sleep Console, mom and baby togetherness is number one,” says Sarah Kaufman, who, together with fellow Clinical Nurse Specialist Sarah Rourke, is spearheading the implementation of ESC in Fraser Health.

Clinical Nurse Specialists Sarah Kaufman (left) and Sarah Rourke (photo credit: Fraser Health)

Perinatal Services BC’s Practice Resource for Care of the Newborn Exposed to Substances During Pregnancy notes that ESC was developed at Yale New Haven Children’s Hospital in New Haven, Connecticut, influenced by the women-centred care provided at FIR (Families in Recovery) at BC Women’s Hospital and Health Centre.

ESC focuses the treatment of NAS on the natural activities of a typical newborn, with the birth parent as the primary provider of care.

A key component of ESC is a care tool that helps identify the newborn’s ability to eat, sleep and be consoled through non-pharmacological care interventions such as skin-to-skin contact, rhythmic movement, and a quiet, low light environment. The ESC care tool was adapted for BC by Perinatal Services BC with permission from the original developers. Pharmacological management is added to the care plan if the newborn is unable to eat, sleep, or be consoled with non-pharmacological interventions.

“Babies have traditionally been separated,” says Kaufman. “But separation is counter-productive unless the baby has a higher level of need.”

Provincial partnership

Known affectionately as “the two Sarahs”, Rourke and Kaufman also played a key role in bringing ESC to the rest of the province.

In 2017, after learning about the work done at Yale New Haven Children’s Hospital, Sarah Rourke and then-colleague Lynne Palmer brought the idea to their partners at Perinatal Services BC.

Later that year, Perinatal Services BC received funding to bring one of the founding developers of the ESC Care Tool to BC to facilitate a one-day workshop for key stakeholders in the province.

In 2018, the Provincial Perinatal Substance Use Project was established to build capacity and support system transformation across the perinatal substance continuum of care. Led by BC Women’s, the project is funded by the Ministry of Health and Ministry of Mental Health and Addictions.

The project supports cross-systems improvements in perinatal substance use services, including partnerships with approximately twenty community organizations—over half of which are Indigenous-led health organizations or friendship centres.

The project, in collaboration with Perinatal Services BC, has also led the collaborative development of education to support health authorities to implement ESC according to their own schedule and needs. The project is also leading a provincial evaluation of the early implementation of ESC.

Support for staff

An important outcome of the project is a suite of e-learning modules that provide education and support for the care of pregnant women impacted by substance use and newborns exposed to substance use during pregnancy.

The modules were designed in partnership by BC Women’s, Perinatal Services BC, Fraser Health, and the UBC Faculty of Medicine’s Division of Continuing Professional Development, with input from collaborators and subject matter experts from across the province.

“With continued open-mindedness and a willingness to do the right thing, we anticipate that ESC will transition from being a new idea to simply being the standard of care for newborns with NAS,” says Jola Berkman, Coordinator, Neonatal Care, Perinatal Services BC.

In addition to the e-learning modules, the Provincial Perinatal Substance Use Project plans to publish a blueprint for perinatal substance use across the continuum of care. When finalized, the document will be posted on the BC Women’s website. The renewed FIR Model of Care, published in March 2020, was the project’s first initiative and has acted as the acute-care model for the provincial blueprint.

“Ultimately, what we’re trying to do is improve perinatal services across the province for women using substances,” says Pamela Joshi, Program Director, Provincial Perinatal Substance Use Project. “The ESC resources are very comforting and empowering because they focus on the assets of the birth parent and their role as the first line of treatment. What is learned in the ESC approach is invaluable to support mother-baby togetherness starting from the early days.”

The project also created a video addressing the stigma that women experience around perinatal substance use:

Looking ahead

Each health authority in BC is currently implementing ESC in varying stages—from planning to full rollout at specific sites.

In Fraser Health, ESC was put into practice at Abbotsford Regional Hospital and Royal Columbian Hospital earlier this year. A rollout at Surrey Memorial Hospital is currently in the works.

In addition to support provided by the Provincial Perinatal Substance Use Project, Fraser Health received a BC SUPPORT Unit Planning Grant to help prepare for implementation.

So far, feedback from providers and patients has been positive and a formal patient feedback survey is in development. The initiative has already led to enhanced linkages with addictions medicine teams in order to connect women with therapy when they’re ready.

BC Patient Safety & Learning System (PSLS) is being used by staff and leaders to identify gaps in care or in the processes put in place to support best care, such as tracking incidents related to connecting families to support services.

ESC has spread in the USA, and BC’s implementation of ESC has sparked interest from other provinces in Canada.

The approach helps demonstrate a province-wide commitment to safe maternal and newborn care, aligning with the theme of the WHO’s second annual World Patient Safety Day, which took place earlier this year on September 17, 2021.

Congratulations on the rollout of ESC and thank you to everyone in BC who supports this initiative!

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