Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, the expectant mother went to the ER after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had built in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and became sick.
Stephanie eventually collapsed. “I need to leave. 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 needed to go home to use once more. She thought she still had several weeks to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was serious, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
A short time later, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – born before term, little but surviving.
When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her pain relief did not work, her last dose of fentanyl had been administered a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her dealer would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I needed help.”
The widespread belief that her love for her baby would make her recover only led to increased guilt and self-harm, a trigger 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 infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would hurt her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Two days later she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.
Hospital staff told her about a care center, 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 newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, custody cases decrease and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, care providers came to collect her.
She departed the institution still in withdrawal, anxious and doubtful about what would come next.
At the care center, Stephanie still feared that authorities would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could walk in and separate them.
For the first two weeks, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about enduring. Substances came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She was unable to care for herself, not to mention anyone else.
Each day, staff from the center transported her to a recovery program, given as medication. Slowly, she was beginning recovery.
She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an specialist – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own family in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a decoration on her head, sitting on the wooden floor with the exit nearby. She is thin. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the young ones to see and they are gathered around, fawning and reaching out to the baby.
Jacob, 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 plan to be a great parent. They will know they are valued.”
Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could be a mom.”
Tools for treating drug-exposed newborns have existed for decades.
The assessment tool was established in 1975|
