Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she had to return to use once more. She thought she still had a month remaining to find a way to become sober and deliver her child.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: 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 departed, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
After five days, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – born before term, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been given four hours before delivery.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she relapsed. She felt without value, criticizing herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her supplier declined to supply to her when she became clearly expecting.
“Yet I was unable,” she said. “I needed help.”
The pervasive expectation that her affection for her child would make her stop using only led to greater shame and negative self-talk, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to tubes and leads, so tiny she thought she would harm 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.
Following a brief period she decided to call her daughter Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and future expenses reduce.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to pick her up.
She left the medical center still in recovery, anxious and doubtful about what would happen next.
At the care center, Stephanie still was concerned that child services would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could enter and remove her child.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Drugs came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She was unable to love herself, much less anyone else.
Daily, staff from the center transported her to a clinic for methadone, given as medication. Gradually, she was beginning recovery.
She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. An advocate, a mentor, came over with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She keeps a photo of the moment. She is clad in black pants and a hoodie, a gray knit hat with a bobble on her head, resting on the floor with the exit nearby. She is slender. Her posture is humble so you cannot see her face. She is holding Izzie up on her lap for the other kids to see and they are gathered around, showing interest to the baby.
One child, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could be a mom.”
Tools for treating infants affected by substances have been available for years.
The assessment tool was developed in 1975|
