Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
Pregnant and experiencing intense discomfort, the expectant mother went to the ER after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was severe, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.
After five days, on a day in November 2022, Stephanie delivered a infant weighing 4lb 8oz – premature, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery multiple times while expecting, and felt horrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her quit only led to greater shame and negative self-talk, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the NICU. When Stephanie at last met her, she was hooked up to tubes and leads, so small she thought she would hurt her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
After two days she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.
Nurses and doctors told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is found to have newborn addiction symptoms regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when families are kept intact, outcomes improve, custody cases decrease and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She departed the institution still in detox, scared and uncertain about what would happen next.
At the facility, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could arrive and remove her child.
For the first two weeks, Stephanie remained isolated. “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 getting by. Addiction came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to hurt her. She lacked the ability to value herself, let alone anyone else.
Every day, staff from the center transported her to a recovery program, 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 getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.
One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She has an image of the moment. She is dressed in casual attire, a gray knit hat with a pompom on her head, resting on the floor with the exit nearby. She is thin. Her head is tilted forward so you do not see her expression. She is lifting the baby on her leg for the other kids to see and they are crowding near, showing interest to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there if possible.
“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I could parent.”
Approaches for managing babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
