Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother visited the ER after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had built 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 became sick.
Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”
She had consumed opioids before coming to the ER and had only a brief window to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and give birth.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.
A short time later, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – born before term, small but alive.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.
She felt sick. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her dealer would not provide to her when she became obviously with child.
“However, I failed,” she said. “I needed help.”
The pervasive expectation that her affection for her child would make her quit only led to deeper self-loathing and self-harm, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.
The infant was moved to the special care nursery. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would hurt her. Embracing her at last, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the nurse who had been so kind to her.
Hospital staff told her about Maddie’s Place, a unique recovery environment where women and their babies are treated together, not apart.
In much of the US, where a baby is found to have infant withdrawal condition regularly, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a small, growing network of centers like the care home is showing an important truth: when families are kept intact, results get better, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, care providers came to pick her up.
She left the medical center still in withdrawal, anxious and doubtful about what would follow.
At the facility, Stephanie still was concerned that authorities would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could arrive and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about enduring. Substances came first; trust came last.
Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to cause pain. She did not know how to value herself, not to mention anyone else.
Each day, staff from the facility took her to a treatment center, given as medication. Slowly, she was embracing sobriety.
She devoted all her time 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 intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could parent.
During a pre-holiday visit, 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 family in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her posture is humble so you cannot see her face. She is holding Izzie up on her leg for the young ones to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I would become a mother.”
Approaches for managing drug-exposed newborns have been available for years.
The Finnegan NAS scale was developed in 1975|
