Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie went to the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had built in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she needed to go home to use once more. She thought she still had a month remaining to find a way to become sober and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the leg infection was critical, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
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 treatment that reduces symptoms and is commonly used in rehabilitation.
A short time later, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – born before term, tiny yet healthy.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.
She felt ill. Ill-equipped for parenting. Undeserving.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she relapsed. She felt hopeless, berating herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her source would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and self-harm, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to monitors, so small she thought she would harm her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the nurse who had been so kind to her.
Hospital staff told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, custody cases decrease and long-term costs decline.
It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to pick her up.
She stepped out of the hospital still in detox, scared and uncertain about what would come next.
At Maddie’s Place, Stephanie still worried that CPS would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could arrive and separate them.
For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Substances came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to value herself, not to mention anyone else.
Daily, staff from Maddie’s Place took her to a recovery program, provided orally. Slowly, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all typical problems 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.
During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a cap with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I found the courage. I could parent.”
Methods to address infants affected by substances have been used for a long time.
The assessment tool was established in 1975|
