Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother arrived at the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to find a way to become sober and deliver her child.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the leg infection was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.
A short time later, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – early, tiny yet healthy.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.
She felt ill. Not ready for motherhood. Not fit.
Stephanie had sought recovery several times during pregnancy, and felt awful each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“However, I failed,” she said. “I required assistance.”
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 easily command her addiction away, any more than she could overcome a persistent condition.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.
Medical personnel told her about a care center, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, results get better, fewer children enter care and overall savings increase.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She departed the institution still in recovery, fearful and unsure about what would happen next.
At the care center, Stephanie still was concerned that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and remove her child.
For the beginning period, 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.”
Life on the streets, she said, was about survival. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to cause pain. She was unable to care for herself, not to mention anyone else.
Daily, staff from the center transported her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.
She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support 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 professional – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I could do this. I could be a mom.
During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She holds a picture of the moment. She is clad in casual attire, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her posture is humble so you cannot see her face. She is holding Izzie up on her lap for the children to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there given the chance.
“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could parent.”
Tools for treating infants affected by substances have been available for years.
The evaluation method was established in 1975|
