Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, a woman named Stephanie visited the hospital emergency room after her infection worsened up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and became sick.
Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids 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 four weeks left to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the leg infection was serious, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie delivered a daughter weighing 4lb 8oz – premature, tiny yet healthy.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been provided shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her source would not provide to her when she became visibly pregnant.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the NICU. When Stephanie eventually visited her, she was attached to monitors, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I looked 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 call her daughter Izzie, after the nurse who had been so kind to her.
Hospital staff told her about a care center, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, results get better, custody cases decrease and long-term costs decline.
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 collect her.
She left the medical center still in withdrawal, fearful and unsure about what would happen next.
At Maddie’s Place, Stephanie still was concerned that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could enter and take her baby away.
For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about getting by. Substances came first; faith came last.
Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to hurt her. She lacked the ability to care for herself, let alone anyone else.
Every day, staff from the center took her to a recovery program, administered in pill form. Slowly, she was starting to get clean.
She utilized each moment 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 intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
On a day prior to the holiday, Stephanie was in the common room, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, visited with her own family in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing casual attire, a cap with a decoration on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you miss her features. She is presenting her daughter on her lap for the young ones to see and they are standing close, admiring and touching to the baby.
A young boy, 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.
“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could parent.”
Approaches for managing babies with exposure have existed for decades.
The assessment tool was created in 1975|
