Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, the expectant mother arrived at the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. 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 arriving at the hospital 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 give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.
Five days later, on a day in November 2022, Stephanie gave birth to a baby girl weighing a small weight – premature, tiny yet healthy.
When the caregiver questioned 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 four hours before delivery.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery several times during pregnancy, and felt awful each time she relapsed. She felt hopeless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The widespread belief that her bond with her newborn would make her stop using only led to greater shame and self-abuse, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was connected to monitors, so tiny she thought she would break her. Embracing her at last, she felt empty. “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 nurse who had been so kind to her.
Hospital staff told her about Maddie’s Place, a new kind of care center where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is diagnosed 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 this facility is proving a simple point: when mothers and babies stay together, results get better, foster placements fall and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to collect her.
She left the medical center still in detox, scared and uncertain about what would follow.
At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could arrive and remove her child.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about survival. Addiction came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to let her down. She was unable to love herself, let alone anyone else.
Each day, staff from the facility took her to a clinic for methadone, given as medication. Over time, she was embracing sobriety.
She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an professional – all common issues for babies affected by withdrawal.
When a child recognizes these infants need affection, then I could do this. I could parent.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. An advocate, a peer support specialist, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, sitting on the wooden floor with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is lifting the baby on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.
One child, eight, asked the parents: “What about the fathers?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. 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. “When a child recognized that newborns require care, then I was able. I could be a mom.”
Tools for treating infants affected by substances have been used for a long time.
The evaluation method was established in 1975|
