Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Eight months pregnant and in severe pain, a woman named Stephanie went to the ER after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had built in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. Withdrawal was setting in. She slumped forward and became sick.
Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
Five days later, on the 12th of November, Stephanie gave birth to a daughter weighing a small weight – premature, tiny yet healthy.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her epidural had failed, her last dose of fentanyl had been administered four hours before delivery.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her source refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I needed help.”
The widespread belief that her love for her baby would make her recover only led to increased guilt and self-harm, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.
The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was connected to monitors, so small she thought she would break her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about a specialized facility, 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 every 18 minutes, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in withdrawal, fearful and unsure about what would follow.
At Maddie’s Place, Stephanie still feared that child services would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and separate them.
For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about survival. Substances came first; faith came last.
Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to let her down. She did not know how to love herself, not to mention anyone else.
Each day, staff from the facility transported her to a clinic for methadone, 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 infant faced feeding challenges at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an professional – all frequent conditions for babies exposed to substances.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for supervised visits with their babies. An advocate, a peer support specialist, stopped by with her own five kids in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She has an image of the moment. She is wearing black pants and a hoodie, a cap with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast so you do not see her expression. She is presenting her daughter 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 moms: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could parent.”
Approaches for managing babies with exposure have existed for decades.
The evaluation method was created in 1975|
