Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother arrived at the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and became sick.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she needed to go home to get high again. She thought she still had a month remaining to plan her recovery and give birth.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, 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 abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.
A short time later, on 12 November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – early, small but alive.
When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her epidural had failed, her last dose of fentanyl had been provided shortly before she gave birth.
She felt unwell. Not ready for motherhood. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, blaming herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her stop using only led to deeper self-loathing and negative self-talk, 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 infant was moved to the special care nursery. When Stephanie eventually visited her, she was hooked up to monitors, so small she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.
Hospital staff told her about a care center, a innovative treatment home 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) every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to collect her.
She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.
At the care center, Stephanie still worried that authorities would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could walk in and remove her child.
For the initial fortnight, Stephanie kept to herself. “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 getting by. Addiction came first; reliance came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to hurt her. She was unable to care for herself, not to mention anyone else.
Daily, staff from Maddie’s Place took her to a recovery program, administered in pill form. Gradually, she was embracing sobriety.
She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an specialist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I found the strength. I could be a mom.
During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, visited with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The young ones stared in awe of the small baby 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 keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a cap with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her posture is humble so you do not see her expression. She is lifting the baby on her lap for the young ones to see and they are gathered around, showing interest to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”
Methods to address babies with exposure have been available for years.
The assessment tool was created in 1975|
