Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the ER after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and vomited.
Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and have this baby.
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 leg infection was critical, but medical staff detected she also had an leakage of amniotic fluid. 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 periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.
After five days, on 12 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 detached. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt without value, criticizing herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her quit only led to greater shame and negative self-talk, a trigger 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 special care nursery. When Stephanie eventually visited her, she was attached to monitors, so little she thought she would break her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
After two days she decided to name her baby after her caregiver, after the professional who provided support to her.
Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.
In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care 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 parents and infants remain united, results get better, fewer children enter care and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, two staff members came to bring her to the facility.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would follow.
At the facility, Stephanie still was concerned that CPS would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could arrive and take her baby away.
For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about enduring. Addiction came first; faith came last.
Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to let her down. She was unable to love herself, let alone anyone else.
Each day, staff from the facility transported her to a recovery program, given as medication. Gradually, she was starting to get clean.
She spent every minute beyond therapy 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 obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all typical problems for babies born with NAS.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, visited with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a pompom on her head, resting on the floor with the exit nearby. She is slender. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there if possible.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could parent.”
Methods to address infants affected by substances have existed for decades.
The assessment tool was created in 1975|
