Fentanyl Addiction During Pregnancy: How Keeping Her Baby Rescued Both Lives.
In her eighth month of pregnancy and suffering, a woman named Stephanie visited the hospital emergency room after her infection worsened up her legs. Without a job or home, separated from loved ones, she lived in a shed she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As physicians addressed her infection, she began to panic. Withdrawal was setting in. She slumped forward and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”
She had taken the drug 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 several weeks to figure out how to get clean and deliver her child.
The attending nurse disagreed. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.
A short time later, on a day in November 2022, Stephanie delivered a infant weighing a small weight – early, tiny yet healthy.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her epidural had failed, her previous intake of fentanyl had been administered four hours before delivery.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt without value, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her source would not provide to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The common assumption that her bond with her newborn would make her quit only led to deeper self-loathing and self-harm, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to monitors, so little she thought she would harm her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name the same as her nurse, after the nurse who had been so kind to her.
Hospital staff told her about a specialized facility, a innovative treatment home where women and their babies are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is proving a simple point: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.
It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to pick her up.
She departed the institution still in detox, scared and uncertain about what would come next.
At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could walk in and remove her child.
For the initial fortnight, Stephanie kept to herself. “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.”
Homelessness, she said, was about survival. Substances came first; faith came last.
Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to cause pain. She lacked the ability to value herself, let alone anyone else.
Every day, staff from the center drove her to a recovery program, provided orally. Gradually, she was embracing sobriety.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I could do this. I would become a mother.
On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. A support specialist, a mentor, visited with her own family in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in wonder 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 holds a picture of the moment. She is clad in casual attire, a beanie with a decoration on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her knee for the children to see and they are standing close, admiring and touching to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I would become a mother.”
Approaches for managing infants affected by substances have been available for years.
The assessment tool was established in 1975|
