Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
In her eighth month of pregnancy and suffering, a woman named Stephanie visited the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had assembled in a companion's property. She was also addicted to fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and became sick.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before coming to the ER and had only a brief window to get treated before she had to return to use once more. She thought she still had several weeks to plan her recovery and deliver her child.
The medical professional intervened. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
After five days, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – premature, tiny yet healthy.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her pain relief did not work, her last dose of fentanyl had been given a few hours prior to birth.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her supplier would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her recover only led to greater shame and negative self-talk, a trigger for her to relapse. 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 special care nursery. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would harm 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.
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 Maddie’s Place, 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 found to have infant withdrawal condition regularly, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to pick her up.
She left the medical center still in recovery, anxious and doubtful about what would come next.
At the facility, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any point, someone could walk in 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 didn’t have a lot of trust at that point.”
Life on the streets, she said, was about survival. Substances came first; trust came last.
Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to hurt her. She lacked the ability to care for herself, much less anyone else.
Each day, staff from the facility transported her to a clinic for methadone, administered in pill form. Over time, she was embracing sobriety.
She utilized each moment when not in sessions 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 nutritional guidance. She also had increased sensitivity and required an professional – all common issues for babies exposed to substances.
Seeing that even a young person understands the need for care, then I could do this. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, visited 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 children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a pompom on her head, resting on the floor with the door behind her. She is lean. Her posture is humble so you do not see her expression. She is holding Izzie up on her leg for the children to see and they are standing close, fawning and reaching out to the baby.
One child, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if they could.
“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I would become a mother.”
Methods to address drug-exposed newborns have been used for a long time.
The Finnegan NAS scale was established in 1975|
