Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Eight months pregnant and in severe pain, a woman named Stephanie visited the medical facility after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before coming to the ER and had just enough time to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and give birth.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was critical, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
After five days, on 12 November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – premature, tiny yet healthy.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been given four hours before delivery.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she failed. She felt worthless, blaming herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her source declined to supply to her when she became obviously with child.
“However, I failed,” she said. “I needed help.”
The pervasive expectation that her love for her baby would make her stop using only led to greater shame and negative self-talk, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would break her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
After two days she decided to give her child the name Izzie, after the professional who provided support to her.
Hospital staff told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to bring her to the facility.
She left the medical center still in recovery, fearful and unsure about what would follow.
At Maddie’s Place, Stephanie still worried that authorities would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could enter and separate them.
For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about getting by. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She was unable to value herself, not to mention anyone else.
Every day, staff from Maddie’s Place transported her to a treatment center, provided orally. Over time, she was beginning recovery.
She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an professional – all frequent conditions for babies born with NAS.
Seeing that even a young person understands the need for care, then I could do this. I could parent.
On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, visited with her own children in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She holds a picture 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 door behind her. She is thin. Her face is downcast so you cannot see her face. She is lifting the baby on her knee for the young ones to see and they are standing close, showing interest to the baby.
One child, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if possible.
“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could be a mom.”
Approaches for managing infants affected by substances have been available for years.
The Finnegan NAS scale was created in 1975|
