Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at the hospital emergency room after her infection worsened up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had built in a friend’s yard. She was also hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie finally broke down. “I need to leave. 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 relapse. She thought she still had four weeks left to find a way to become sober and have this baby.
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 infection in her legs was serious, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – premature, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been administered four hours before delivery.
She felt sick. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt hopeless, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her dealer would not provide to her when she became obviously with child.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was hooked up 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, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where women and their babies are treated together, not apart.
In numerous states, where a baby is diagnosed with infant withdrawal condition every 18 minutes, 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 the care home is proving a simple point: when mothers and babies stay together, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in recovery, anxious and doubtful about what would happen next.
At the facility, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and separate them.
For the initial fortnight, Stephanie kept to herself. “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 survival. Drugs came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She was unable to care for herself, not to mention anyone else.
Every day, staff from the facility drove her to a treatment center, provided orally. Over time, she was beginning recovery.
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 sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all typical problems for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. An advocate, a mentor, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She has an image of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, seated on the ground with the door behind her. 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 crowding near, 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 men were occupied, engaged elsewhere, that they would be there if possible.
“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 Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could be a mom.”
Approaches for managing drug-exposed newborns have existed for decades.
The assessment tool was established in 1975|
