Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also addicted to fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”
She had taken the drug 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 find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.
A short time later, on a day in November 2022, Stephanie delivered a infant weighing 4lb 8oz – early, little but surviving.
When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided four hours before delivery.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her source would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her love for her baby would make her stop using only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.
The infant was moved to the NICU. When Stephanie finally saw her her, she was hooked up to monitors, so small she thought she would hurt her. Embracing her at last, she felt detached. “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 call her daughter Izzie, after the nurse who had been so kind to her.
Medical personnel told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like the care home is demonstrating a key fact: when parents and infants remain united, recovery succeeds, foster placements fall and future expenses reduce.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to pick her up.
She departed the institution still in recovery, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still worried that CPS would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could enter and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about enduring. Drugs came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to hurt her. She did not know how to care for herself, let alone anyone else.
Each day, staff from the center transported her to a clinic for methadone, administered in pill form. Gradually, she was starting to get clean.
She spent every minute outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an specialist – all common issues for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own family in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She has an image of the moment. She is clad in dark trousers and a sweatshirt, a cap with a pompom on her head, resting on the floor with the door behind her. She is slender. Her posture is humble so you do not see her expression. She is holding Izzie up on her leg for the children to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the moms: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there given the chance.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”
Approaches for managing drug-exposed newborns have been available for years.
The assessment tool was developed in 1975|
