Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
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. Jobless and without shelter, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and became sick.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”
She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had several weeks to plan her recovery and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the doctors would not let her go: the leg infection was critical, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.
A short time later, on a day in November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, little but surviving.
When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she relapsed. She felt worthless, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became obviously with child.
“However, I failed,” she said. “I needed help.”
The pervasive expectation that her affection for her child would make her quit only led to increased guilt and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would break her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to name her baby after her caregiver, after the professional who provided support to her.
Nurses and doctors told her about Maddie’s Place, a innovative treatment home where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is identified with newborn addiction symptoms frequently, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a small, growing network of centers like this facility is showing an important truth: when families are kept intact, results get better, fewer children enter care and overall savings increase.
It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to pick her up.
She departed the institution still in recovery, fearful and unsure about what would follow.
At the facility, Stephanie still was concerned that CPS would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could enter and take her baby away.
For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about getting by. Drugs came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. 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 facility drove her to a treatment center, administered in pill form. Slowly, she was starting to get clean.
She devoted all her time outside treatment 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 severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in admiration 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. Such issues were irrelevant.”
She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a cap with a pompom on her head, sitting on the wooden floor with the door behind her. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her knee for the young ones to see and they are crowding near, fawning and reaching out to the baby.
One child, eight, asked the moms: “Why are there no men?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”
Methods to address infants affected by substances have been used for a long time.
The evaluation method was developed in 1975|
