Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the ER after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and vomited.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she had to return to relapse. She thought she still had four weeks left to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing a small weight – early, tiny yet healthy.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she relapsed. She felt without value, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I needed help.”
The pervasive expectation that her bond with her newborn would make her stop using only led to increased guilt and self-abuse, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would harm her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
After two days she decided to name her baby the same as her nurse, after the professional who provided support to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center where women and their babies are supported as a unit, not apart.
In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to collect her.
She left the medical center still in withdrawal, scared and uncertain about what would happen next.
At the facility, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could enter and take her baby away.
For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about getting by. Substances came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She lacked the ability to value herself, let alone anyone else.
Every day, staff from the center took her to a recovery program, administered in pill form. Gradually, she was beginning recovery.
She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an professional – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own five kids in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in awe of the tiny infant 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 keeps a photo of the moment. She is wearing casual attire, a cap with a decoration on her head, resting on the floor with the entryway at her back. She is lean. Her posture is humble so you cannot see her face. She is presenting her daughter on her lap for the other kids to see and they are standing close, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The women attempted to clarify 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 broke down,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”
Methods to address babies with exposure have been used for a long time.
The Finnegan NAS scale was established in 1975|
