Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
Pregnant and experiencing intense discomfort, a woman named Stephanie visited the ER after an infection began spreading up her legs. Without a job or home, estranged from her family, she resided in a small structure she had constructed in a acquaintance's garden. She was also hooked on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and threw up.
Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave 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.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
After five days, on a day in November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – premature, tiny yet healthy.
When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been administered shortly before she gave birth.
She felt ill. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt worthless, berating herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her source would not provide to her when she became obviously with child.
“However, I failed,” she said. “I needed help.”
The widespread belief that her love for her baby would make her stop using only led to increased guilt and negative self-talk, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was attached to medical equipment, so little she thought she would hurt her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where women and their babies are treated together, not apart.
In much of the US, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and overall savings increase.
It took Stephanie some time to build confidence 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 withdrawal, anxious and doubtful about what would happen next.
At the facility, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could enter and separate them.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Homelessness, she said, was about enduring. Substances came first; reliance came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to hurt her. She did not know how to care for herself, much less anyone else.
Each day, staff from the center drove her to a clinic for methadone, given as medication. Slowly, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She has an image of the moment. She is wearing black pants and a hoodie, a cap with a decoration on her head, seated on the ground with the door behind her. She is slender. Her face is downcast so you do not see her expression. She is presenting her daughter on her leg for the children to see and they are standing close, admiring and touching to the baby.
Jacob, eight, asked the parents: “Why are there no men?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I could parent.”
Tools for treating drug-exposed newborns have existed for decades.
The evaluation method was created in 1975|
