Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother arrived at the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
After five days, on a day in November 2022, Stephanie had a daughter weighing just over four pounds – early, tiny yet healthy.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was numb. Her epidural had failed, her previous intake of fentanyl had been provided shortly before she gave birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I needed help.”
The widespread belief that her bond with her newborn would make her recover only led to deeper self-loathing and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The baby was taken to the special care nursery. When Stephanie eventually visited her, she was attached to medical equipment, so small she thought she would break her. Embracing her at last, she felt empty. “I looked at 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 name her baby after her caregiver, after the attendant who showed compassion to her.
Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to collect her.
She departed the institution still in recovery, fearful and unsure about what would happen next.
At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could enter and remove her child.
For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; faith came last.
Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to hurt her. She lacked the ability to love herself, much less anyone else.
Every day, staff from the center drove her to a clinic for methadone, provided orally. Gradually, she was starting to get clean.
She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all common issues for babies exposed to substances.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. An advocate, a mentor, visited with her own five kids in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in awe of the tiny infant 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 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 slender. Her posture is humble so you miss her features. She is lifting the baby on her leg for the young ones to see and they are crowding near, showing interest to the baby.
One child, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there given the chance.
“When I have kids,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
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 could be a mom.”
Tools for treating babies with exposure have been available for years.
The evaluation method was created in 1975|
