Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
In her eighth month of pregnancy and suffering, the expectant mother visited the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had built in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to figure out how to get clean and deliver her child.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was serious, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
A short time later, on a day in November 2022, Stephanie delivered a baby girl weighing just over four pounds – born before term, small but alive.
When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she relapsed. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her supplier would not provide to her when she became clearly expecting.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her stop using only led to deeper self-loathing and negative self-talk, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.
The baby was taken to the NICU. When Stephanie finally saw her her, she was attached to tubes and leads, so small she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
After two days she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.
Hospital staff told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.
In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a developing system of centers like the care home is proving a simple point: when mothers and babies stay together, recovery succeeds, custody cases decrease and long-term costs decline.
It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, care providers came to bring her to the facility.
She stepped out of the hospital still in recovery, anxious and doubtful about what would happen next.
At Maddie’s Place, Stephanie still was concerned that CPS would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could arrive and remove her child.
For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Drugs came first; faith came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to value herself, not to mention anyone else.
Every day, staff from the center transported her to a clinic for methadone, provided orally. Slowly, she was starting to get clean.
She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all typical problems for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. A support specialist, a recovery coach, came over with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She keeps a photo of the moment. She is dressed in casual attire, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is thin. Her posture is humble so you miss her features. She is holding Izzie up on her lap for the young ones to see and they are crowding near, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if they could.
“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I would become a mother.”
Approaches for managing babies with exposure have existed for decades.
The evaluation method was developed in 1975|
