Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother visited the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she had to return to get high again. She thought she still had a month remaining to find a way to become sober and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was critical, 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 be at risk of death.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.
Five days later, on 12 November 2022, Stephanie gave birth to a infant weighing just over four pounds – born before term, tiny yet healthy.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her epidural had failed, her last dose of fentanyl had been provided four hours before delivery.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery repeatedly before birth, and felt horrible each time she failed. She felt without value, blaming herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her source declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I required assistance.”
The widespread belief that her love for her baby would make her quit only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was attached to tubes and leads, so small she thought she would break her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to call her daughter the same as her nurse, after the professional who provided support to her.
Hospital staff told her about a care center, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.
In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like this facility is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, two staff members came to bring her to the facility.
She departed the institution still in detox, scared and uncertain about what would come next.
At Maddie’s Place, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and separate them.
For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about survival. Drugs came first; faith 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 love herself, much less anyone else.
Every day, staff from Maddie’s Place took her to a treatment center, provided orally. Slowly, she was starting to get clean.
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 adverse reactions to milk and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an specialist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. An advocate, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a bobble on her head, resting on the floor with the exit nearby. She is slender. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the young ones to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could be a mom.”
Tools for treating drug-exposed newborns have existed for decades.
The Finnegan NAS scale was created in 1975|
