Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother visited the ER after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. Withdrawal was setting in. She slumped forward and threw up.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had used fentanyl before arriving at the hospital and had just enough time to get treated before she had to return to use once more. She thought she still had several weeks to plan her recovery and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
After five days, on the 12th of November, Stephanie delivered a daughter weighing 4lb 8oz – early, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been provided four hours before delivery.
She felt unwell. Ill-equipped for parenting. Undeserving.
Stephanie had sought recovery multiple times while expecting, and felt awful each time she was unsuccessful. She felt worthless, berating herself for not being able to achieve the unattainable. An OBGYN 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 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 use again. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the NICU. When Stephanie eventually visited her, she was hooked up to tubes and leads, so little she thought she would harm her. Embracing her at last, she felt detached. “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 name her baby Izzie, after the nurse who had been so kind 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 supported as a unit, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, outcomes improve, custody cases decrease and future expenses reduce.
It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, care providers came to bring her to the facility.
She departed the institution still in withdrawal, scared and uncertain about what would come next.
At the care center, Stephanie still worried that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could enter and separate them.
For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, 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 hurt her. She lacked the ability to love herself, much less anyone else.
Each day, staff from the center transported her to a recovery program, administered in pill form. Over time, she was starting to get clean.
She devoted all her time outside treatment 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 increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.
When a child recognizes these infants need affection, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a recovery coach, visited with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
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 entryway at her back. She is thin. Her posture is humble so you do not see her expression. She is presenting her daughter on her leg for the children to see and they are standing close, showing interest to the baby.
One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I would become a mother.”
Methods to address infants affected by substances have been used for a long time.
The assessment tool was created in 1975|
