Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
In her eighth month of pregnancy and suffering, the expectant mother went to the ER after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”
She had used fentanyl before coming to the ER and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
Five days later, on a day in November 2022, Stephanie had a daughter weighing just over four pounds – premature, tiny yet healthy.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her supplier declined to supply to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The pervasive expectation that her love for her baby would make her recover only led to increased guilt and self-harm, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to monitors, so small she thought she would harm her. Holding her for the first time, she felt empty. “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 call her daughter after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a new kind of care center where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is identified with newborn addiction symptoms regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.
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 stepped out of the hospital still in recovery, anxious and doubtful about what would come next.
At Maddie’s Place, Stephanie still was concerned that CPS would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and take her baby away.
For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Homelessness, she said, was about getting by. Substances came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to cause pain. She lacked the ability to care for herself, let alone anyone else.
Every day, staff from the facility transported her to a recovery program, administered in pill form. Gradually, she was starting to get clean.
She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, came over with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She holds a picture of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the exit nearby. She is slender. Her posture is humble so you cannot see her face. She is lifting the baby on her lap for the other kids to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could be a mom.”
Methods to address infants affected by substances have existed for decades.
The Finnegan NAS scale was created in 1975|
