Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the medical facility 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 friend’s yard. She was also dependent on fentanyl.
As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she had to return to get high again. She thought she still had a month remaining to plan her recovery and deliver her child.
The attending nurse disagreed. 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 leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – early, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her pain relief did not work, her final administration of fentanyl had been given four hours before delivery.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery multiple times while expecting, and felt awful each time she relapsed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her recover only led to greater shame and negative self-talk, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the special care nursery. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would harm her. Embracing her at last, she felt detached. “I just stared at 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 Izzie, after the attendant who showed compassion to her.
Hospital staff told her about a care center, a innovative treatment home where women and their babies are supported as a unit, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition regularly, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, recovery succeeds, fewer children enter care and future expenses reduce.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to collect her.
She stepped out of the hospital still in detox, anxious and doubtful about what would happen next.
At the care center, Stephanie still feared that child services would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could walk in and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Addiction came first; trust came last.
Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She was unable to value herself, let alone anyone else.
Daily, staff from the center drove her to a clinic for methadone, provided orally. Slowly, she was embracing sobriety.
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 adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an specialist – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a recovery coach, stopped by with her own family 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 wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a pompom on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her knee for the children to see and they are crowding near, showing interest to the baby.
A young boy, eight, asked the moms: “Why are there no men?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand 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|
