Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie went to the medical facility after her infection worsened up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had taken the drug before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had several weeks to figure out how to get clean and deliver her child.
The medical professional intervened. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, 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 be at risk of death.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
Five days later, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – premature, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her dealer would not provide to her when she became clearly expecting.
“However, I failed,” she said. “I required assistance.”
The widespread belief that her love for her baby would make her recover only led to greater shame and self-harm, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.
The infant was moved to the special care nursery. When Stephanie at last met her, she was connected to monitors, so small she thought she would harm her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.
Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is showing an important truth: when families are kept intact, results get better, foster placements fall and overall savings increase.
It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified 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 Maddie’s Place, Stephanie still feared that authorities would come seize her child – 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 remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Drugs came first; faith came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She did not know how to love herself, much less anyone else.
Every day, staff from the facility drove her to a treatment center, provided orally. Over time, she was embracing sobriety.
She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an professional – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, 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 monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She has an image of the moment. She is wearing black pants and a hoodie, a gray knit hat 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 cannot see her face. She is holding Izzie up on her lap for the other kids to see and they are standing close, fawning and reaching out to the baby.
One child, eight, asked the mothers: “Why are there no men?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and her companion made eye contact. “I just lost it and fell apart,” 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 Finnegan NAS scale was developed in 1975|