Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie went to the ER after her infection worsened up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.
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 was compelled to leave to get high again. She thought she still had a month remaining to plan her recovery and have this baby.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the doctors would not let her go: 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 left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
Five days later, on a day in November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – born before term, little but surviving.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her epidural had failed, her previous intake of fentanyl had been administered shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt hopeless, berating herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier would not provide to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her quit only led to greater shame and self-abuse, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to monitors, so small she thought she would hurt her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart.
In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, results get better, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to collect her.
She stepped out of the hospital still in recovery, fearful and unsure about what would come next.
At the care center, Stephanie still feared that child services would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could enter and separate them.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to let her down. She lacked the ability to care for herself, not to mention anyone else.
Every day, staff from the facility took her to a clinic for methadone, given as medication. Over time, she was embracing sobriety.
She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies born with NAS.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a mentor, stopped by with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a cap with a bobble on her head, resting on the floor with the exit nearby. She is thin. Her face is downcast so you do not see her expression. She is lifting the baby on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if possible.
“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and the specialist exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”
Approaches for managing infants affected by substances have been used for a long time.
The evaluation method was established in 1975|
