Fentanyl Addiction During Pregnancy: How Keeping Her Baby Rescued Both Lives.
In her eighth month of pregnancy and suffering, the expectant mother arrived at the ER after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had constructed in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and became sick.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had just enough time to get treated before she had to return to get high again. She thought she still had a month remaining to plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the leg infection was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie delivered a infant weighing a small weight – early, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given shortly before she gave birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her quit only led to greater shame and self-harm, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to tubes and leads, so small she thought she would harm her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
After two days she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Hospital staff told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and overall savings increase.
It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to pick her up.
She departed the institution still in withdrawal, fearful and unsure about what would happen next.
At the facility, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could walk in and take her baby away.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about enduring. Substances came first; faith came last.
Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to let her down. She lacked the ability to care for herself, let alone anyone else.
Every day, staff from the center drove her to a clinic for methadone, administered in pill form. Slowly, she was starting to get clean.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a mentor, visited with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” 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 black pants and a hoodie, a beanie with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her lap for the other kids to see and they are crowding near, admiring and touching to the baby.
A young boy, eight, asked the parents: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” 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 these babies deserve to be loved, then I could do this. I could be a mom.”
Methods to address infants affected by substances have been available for years.
The evaluation method was created in 1975|
