Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother went to the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a companion's property. She was also hooked on fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie eventually collapsed. “I need to leave. 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 a month remaining to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, 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 frequently utilized in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie delivered a daughter weighing 4lb 8oz – premature, small but alive.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean repeatedly before birth, and felt awful each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The common assumption that her love for her baby would make her quit only led to deeper self-loathing and negative self-talk, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the NICU. When Stephanie finally saw her her, she was hooked up to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to give her child the name after her caregiver, after the professional who provided support to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where women and their babies are cared for jointly, not apart.
In numerous states, where a baby is diagnosed with infant withdrawal condition regularly, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a small, growing network of centers like this facility is showing an important truth: when parents and infants remain united, outcomes improve, custody cases decrease and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to collect her.
She departed the institution 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 hesitant about parenting. The fear lingered: that at any point, someone could enter and remove her child.
For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Substances came first; reliance came last.
Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to cause pain. She was unable to love herself, not to mention anyone else.
Each day, staff from the center transported her to a recovery program, provided orally. 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 daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The young ones stared in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She has an image of the moment. She is dressed in casual attire, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her lap for the young ones to see and they are standing close, admiring and touching to the baby.
One child, eight, asked the mothers: “Why are there no men?” The parents responded that the men were occupied, handling responsibilities, that they would be there if possible.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could be a mom.”
Approaches for managing babies with exposure have existed for decades.
The assessment tool was established in 1975|
