Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother went to the medical facility after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had built in a friend’s yard. She was also hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and became sick.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had a month remaining to find a way to become sober and have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.
Five days later, on a day in November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – born before term, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her epidural had failed, 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 several times during pregnancy, and felt awful each time she failed. She felt worthless, berating herself for not being able to achieve the unattainable. An doctor told her to “only” 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 pervasive expectation that her bond with her newborn would make her recover only led to greater shame and self-harm, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Nurses and doctors told her about Maddie’s Place, a innovative treatment home where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is showing an important truth: when mothers and babies stay together, outcomes improve, fewer children enter care and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to pick her up.
She stepped out of the hospital still in withdrawal, fearful and unsure about what would follow.
At the care center, Stephanie still feared that CPS would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could walk in and separate them.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to let her down. She was unable to care for herself, much less anyone else.
Every day, staff from the center took her to a recovery program, administered in pill form. Gradually, she was starting to get clean.
She spent every minute when not in sessions 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 obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an specialist – all frequent conditions for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I could do this. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. An advocate, a recovery coach, came over with her own family in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing black pants and a hoodie, a gray knit hat with a bobble on her head, resting on the floor with the door behind her. She is thin. Her posture is humble so you cannot see her face. She is presenting her daughter on her lap for the children to see and they are standing close, admiring and touching to the baby.
A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I could parent.”
Approaches for managing drug-exposed newborns have been used for a long time.
The assessment tool was developed in 1975|
