Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother arrived at the medical facility after an infection began spreading up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had assembled in a companion's property. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but medical staff detected 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.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.
A short time later, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – born before term, tiny yet healthy.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she relapsed. She felt hopeless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her supplier declined to supply to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her quit only led to greater shame and self-abuse, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would hurt her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, 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 the care home is proving a simple point: when parents and infants remain united, recovery succeeds, foster placements fall 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, care providers came to pick her up.
She left the medical center still in detox, anxious and doubtful about what would come next.
At the care center, Stephanie still feared that authorities would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could enter and separate them.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about getting by. Addiction came first; faith came last.
Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to let her down. She was unable to care for herself, not to mention anyone else.
Daily, staff from the facility transported her to a treatment center, 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 receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an professional – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I found the strength. I could parent.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in awe of the small baby 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 holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a cap with a pompom on her head, seated on the ground with the door behind her. She is thin. Her posture is humble so you cannot see her face. She is lifting the baby on her leg for the children to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if they could.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could be a mom.”
Approaches for managing drug-exposed newborns have been used for a long time.
The Finnegan NAS scale was created in 1975|