Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.
As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and threw up.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had several weeks to find a way to become sober and deliver her child.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was critical, but doctors had discovered she also had an ruptured membrane. 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 regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – born before term, small but alive.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her epidural had failed, her previous intake of fentanyl had been provided a few hours prior to birth.
She felt ill. Not ready for motherhood. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, blaming 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 obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her bond with her newborn would make her quit only led to increased guilt and negative self-talk, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was attached to medical equipment, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
After two days she decided to give her child the name Izzie, after the attendant who showed compassion to her.
Nurses and doctors told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is proving a simple point: when families are kept intact, results get better, custody cases decrease and long-term costs decline.
It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to collect her.
She stepped out of the hospital still in withdrawal, fearful and unsure about what would come next.
At the facility, Stephanie still was concerned that CPS would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could walk in and take her baby away.
For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to value herself, much less anyone else.
Daily, staff from the center drove her to a recovery program, given as medication. Slowly, she was embracing sobriety.
She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an specialist – all typical problems for babies exposed to substances.
When a child recognizes these infants need affection, then I found the strength. I could be a mom.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a recovery coach, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She holds a picture 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 lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her lap for the young ones to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I would become a mother.”
Tools for treating drug-exposed newborns have been available for years.
The evaluation method was developed in 1975|
