Fentanyl Addiction During Pregnancy: How Keeping Her Baby Rescued Both Lives.
Eight months pregnant and in severe pain, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had constructed in a acquaintance's garden. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and threw up.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had a month remaining to figure out how to get clean and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was critical, but doctors had discovered 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.
She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – early, tiny yet healthy.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been provided four hours before delivery.
She felt sick. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became obviously with child.
“However, I failed,” she said. “I had to seek support.”
The widespread belief that her bond with her newborn would make her recover only led to increased guilt and self-harm, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.
The baby was taken to the NICU. When Stephanie at last met her, she was hooked up to monitors, so little she thought she would hurt her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
After two days she decided to name her baby Izzie, after the attendant who showed compassion to her.
Medical personnel told her about a specialized facility, 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 identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a developing system of centers like this facility is proving a simple point: when families are kept intact, recovery succeeds, foster placements fall and future expenses reduce.
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, two staff members came to collect her.
She stepped out of the hospital still in withdrawal, fearful and unsure about what would come next.
At Maddie’s Place, Stephanie still feared that authorities would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could enter and take her baby away.
For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Homelessness, she said, was about enduring. Substances came first; trust came last.
Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to let her down. She lacked the ability to care for herself, much less anyone else.
Every day, staff from Maddie’s Place transported her to a recovery program, 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 girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all common issues for babies affected by withdrawal.
When a child recognizes these infants need affection, then I found the strength. I could be a mom.
On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own family in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The young ones stared 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. Such issues were irrelevant.”
She has an image of the moment. She is clad in casual attire, a beanie with a bobble on her head, resting on the floor with the door behind her. She is thin. Her posture is humble so you miss her features. She is holding Izzie up on her leg for the children to see and they are crowding near, fawning and reaching out to the baby.
One child, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could parent.”
Approaches for managing drug-exposed newborns have existed for decades.
The Finnegan NAS scale was developed in 1975|
