Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
In her eighth month of pregnancy and suffering, a woman named Stephanie went to the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was serious, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.
A short time later, on the 12th of November, Stephanie delivered a daughter weighing a small weight – born before term, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been provided shortly before she gave birth.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt worthless, berating herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her source declined to supply to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her bond with her newborn would make her quit only led to greater shame 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 infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to tubes and leads, so small she thought she would harm her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Two days later 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 specialized facility, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.
In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, outcomes improve, foster placements fall and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to pick her up.
She left the medical center still in detox, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still worried that child services would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any time, someone could walk in and remove her child.
For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about survival. 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 hurt her. She was unable to love herself, let alone anyone else.
Each day, staff from Maddie’s Place took her to a recovery program, provided orally. Slowly, she was embracing sobriety.
She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all typical problems for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.
One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, visited with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” 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 dressed in casual attire, a cap with a decoration on her head, resting on the floor with the exit nearby. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there given the chance.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could be a mom.”
Approaches for managing infants affected by substances have existed for decades.
The assessment tool was developed in 1975|
