Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother went to the ER after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had constructed in a companion's property. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she had to return to use once more. She thought she still had several weeks to find a way to become sober and have this baby.
The medical professional intervened. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.
Five days later, on 12 November 2022, Stephanie delivered a infant weighing 4lb 8oz – early, tiny yet healthy.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her epidural had failed, her final administration of fentanyl had been given shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she failed. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her dealer refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her stop using only led to increased guilt and self-abuse, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The newborn was transferred to the NICU. When Stephanie at last met her, she was attached to monitors, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
After two days she decided to call her daughter after her caregiver, after the professional who provided support to her.
Hospital staff told her about a specialized facility, a new kind of care center where women and their babies are cared for jointly, 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 treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.
She departed the institution still in detox, fearful and unsure about what would happen next.
At the care center, Stephanie still was concerned that child services would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could arrive and remove her child.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She lacked the ability to care for herself, not to mention anyone else.
Daily, staff from Maddie’s Place transported her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.
She devoted all her time when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an specialist – all frequent conditions for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. A support specialist, a mentor, visited with her own family 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 wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is lean. 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 crowding near, admiring and touching to the baby.
A young boy, eight, asked the moms: “Why are there no men?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if possible.
“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”
Methods to address babies with exposure have existed for decades.
The assessment tool was created in 1975|
