Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Pregnant and experiencing intense discomfort, a woman named Stephanie went to the ER after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a companion's property. She was also dependent on fentanyl.
As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and became sick.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had four weeks left 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 hospital refused to discharge her: the condition in her limbs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.
A short time later, on the 12th of November, Stephanie delivered a baby girl weighing just over four pounds – early, tiny yet healthy.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been provided a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Unworthy.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her dealer declined to supply to her when she became clearly expecting.
“However, I failed,” she said. “I needed help.”
The widespread belief that her affection for her child would make her recover only led to increased guilt and self-abuse, a cause for her to use again. 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 eventually visited her, she was attached to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.
Hospital staff told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to collect her.
She stepped out of the hospital still in detox, fearful and unsure about what would come next.
At Maddie’s Place, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could walk in and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about getting by. Substances came first; reliance came last.
Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She was unable to value herself, let alone anyone else.
Every day, staff from Maddie’s Place transported her to a recovery program, given as medication. Over time, she was embracing sobriety.
She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.
On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a recovery coach, stopped by with her own five kids 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 little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She keeps a photo of the moment. She is clad in black pants and a hoodie, a cap with a bobble on her head, sitting on the wooden floor with the door behind her. She is lean. Her posture is humble so you miss her features. She is holding Izzie up on her knee for the young ones to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could parent.”
Approaches for managing drug-exposed newborns have existed for decades.
The assessment tool was created in 1975|
