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 a serious infection started to spread up her legs. Without a job or home, estranged from her family, she lived in a shed she had built in a acquaintance's garden. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she needed to go home to use once more. She thought she still had four weeks left to plan her recovery and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – early, tiny yet healthy.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been given shortly before she gave birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she relapsed. She felt hopeless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her source would not provide to her when she became obviously with child.
“But I couldn’t,” she said. “I had to seek support.”
The common assumption that her love for her baby would make her stop using only led to increased guilt and self-abuse, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.
The newborn was transferred 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. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
After two days she decided to call her daughter Izzie, after the professional who provided support to her.
Medical personnel told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is identified with infant withdrawal condition frequently, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, 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 ensuring she qualified for the program, two staff members came to collect her.
She departed the institution still in detox, anxious and doubtful about what would come next.
At the facility, Stephanie still was concerned that authorities would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could walk in and take her baby away.
For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about enduring. Addiction came first; faith came last.
Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to cause pain. She was unable to love herself, not to mention anyone else.
Every day, staff from the facility transported her to a treatment center, administered in pill form. Gradually, she was beginning recovery.
She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all frequent conditions for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie was in the common room, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in awe of the tiny infant 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 clad in black pants and a hoodie, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is slender. Her face is downcast so you do not see her expression. She is holding Izzie up on her lap for the young ones to see and they are crowding near, admiring and touching to the baby.
One child, eight, asked the moms: “Where are all the dads?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I would become a mother.”
Methods to address infants affected by substances have existed for decades.
The evaluation method was created in 1975|