Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother visited the ER after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”
She had taken the drug before seeking medical help and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had several weeks to plan her recovery and deliver her child.
The medical professional intervened. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was serious, but doctors had discovered she also had an amniotic fluid leak. 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 at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie had a daughter weighing 4lb 8oz – born before term, small but alive.
When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her source declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I required assistance.”
The common assumption that her affection for her child would make her recover only led to increased guilt and self-harm, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the NICU. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would break her. Embracing her at last, she felt nothing. “I just stared 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 name her baby Izzie, after the attendant who showed compassion to her.
Hospital staff told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are treated together, not apart.
In numerous states, where a baby is identified with newborn addiction symptoms regularly, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.
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 bring her to the facility.
She stepped out of the hospital still in detox, fearful and unsure about what would follow.
At Maddie’s Place, Stephanie still feared that authorities would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could enter and remove her child.
For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about survival. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to cause pain. She lacked the ability to care for herself, not to mention anyone else.
Each day, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Gradually, she was starting to get clean.
She spent every minute 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 adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all typical problems for babies born with NAS.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, came over with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in awe of the small baby in Stephanie’s arms. “They were innocent,” 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 pompom on her head, sitting on the wooden floor with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is lifting the baby on her leg for the young ones to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could parent.”
Methods to address babies with exposure have existed for decades.
The assessment tool was established in 1975|
