Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother visited the ER after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and became sick.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids 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 figure out how to get clean and give birth.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
After five days, on 12 November 2022, Stephanie gave birth to a daughter weighing a small weight – born before term, small but alive.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given a few hours prior to birth.
She felt ill. Not ready for motherhood. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.
“However, I failed,” she said. “I required assistance.”
The pervasive expectation that her affection for her child would make her quit only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The baby was taken to the special care nursery. When Stephanie at last met her, she was connected to tubes and leads, so small she thought she would break her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to call her daughter Izzie, after the nurse who had been so kind to her.
Hospital staff told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.
In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, outcomes improve, foster placements fall and future expenses reduce.
It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to pick her up.
She left the medical center still in withdrawal, scared and uncertain about what would come next.
At the care center, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could arrive and take her baby away.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Substances came first; trust came last.
Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She was unable to care for herself, not to mention anyone else.
Every day, staff from the facility transported her to a treatment center, provided orally. Over time, she was starting to get clean.
She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, stopped by with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She has an image of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a bobble on her head, seated on the ground with the door behind her. She is thin. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the young ones to see and they are crowding near, admiring and touching to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I would become a mother.”
Methods to address infants affected by substances have been used for a long time.
The evaluation method was established in 1975|
