Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother visited the medical facility after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a companion's property. She was also hooked on fentanyl.
As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and threw up.
Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the infection in her legs was critical, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – early, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.
She felt unwell. Ill-equipped for parenting. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt awful each time she failed. She felt without value, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“However, I failed,” she said. “I had to seek support.”
The common assumption that her affection for her child would make her quit only led to greater shame 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 overcome a chronic disease.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would hurt her. Cradling her initially, she felt nothing. “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.
Two days later she decided to name her baby 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 diagnosed with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to bring her to the facility.
She stepped out of the hospital still in withdrawal, scared and uncertain about what would follow.
At Maddie’s Place, Stephanie still was concerned that child services would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. Drugs came first; trust came last.
Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to love herself, much less anyone else.
Daily, staff from the facility drove her to a clinic for methadone, administered in pill form. Over time, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I could do this. I would become a mother.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. An advocate, a recovery coach, stopped by with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She has an image of the moment. She is clad in black pants and a hoodie, a beanie with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her head is tilted forward so you do not see her expression. 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.
A young boy, eight, asked the parents: “What about the fathers?” The parents responded that the dads were busy, called away to other tasks, that they would be there given the chance.
“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I was able. I would become a mother.”
Approaches for managing babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
