Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at the ER after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and vomited.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”
She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had several weeks to plan her recovery and have this baby.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in addiction recovery.
Five days later, on a day in November 2022, Stephanie had a infant weighing a small weight – early, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her epidural had failed, her last dose of fentanyl had been administered four hours before delivery.
She felt sick. Not ready for motherhood. 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 do the impossible. An obstetrician told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her quit only led to greater shame and negative self-talk, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.
The infant was moved to the NICU. When Stephanie eventually visited her, she was attached to medical equipment, so small she thought she would harm her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to give her child the name the same as her nurse, after the professional who provided support to her.
Hospital staff told her about a care center, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.
In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when families are kept intact, outcomes improve, foster placements fall and future expenses reduce.
It took Stephanie some time to build confidence 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 left the medical center still in recovery, scared and uncertain about what would follow.
At the facility, Stephanie still feared that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could arrive and remove her child.
For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. Substances came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She lacked the ability to value herself, not to mention anyone else.
Every day, staff from the facility drove her to a treatment center, provided orally. Slowly, she was beginning recovery.
She spent every minute 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 increased sensitivity and required an specialist – all typical problems for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. An advocate, a mentor, came over with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a cap with a pompom on her head, seated on the ground with the door behind her. She is thin. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her leg for the young ones to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the parents: “What about the fathers?” The parents responded that the dads were busy, called away to other tasks, that they would be there if they could.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could be a mom.”
Methods to address infants affected by substances have been used for a long time.
The Finnegan NAS scale was developed in 1975|
