Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
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, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a companion's property. She was also hooked on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and became sick.
Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to get high again. She thought she still had a month remaining to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.
After five days, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – early, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her dealer declined to supply to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The common assumption that her love for her baby would make her recover only led to increased guilt and self-harm, 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 infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to tubes and leads, so tiny she thought she would hurt her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to name her baby after her caregiver, after the professional who provided support to her.
Medical personnel told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is showing an important truth: 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 eventually made the call. After verifying her eligibility 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 happen next.
At the care center, Stephanie still feared that authorities would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could enter and take her baby away.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about survival. Substances came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to hurt her. She did not know how to love herself, let alone anyone else.
Every day, staff from the facility drove her to a recovery program, provided orally. Over time, she was embracing sobriety.
She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges 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 frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I was capable. I would become a mother.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a peer support specialist, came over with her own children in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in awe 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 pompom on her head, resting on the floor with the entryway at her back. She is thin. Her head is tilted forward so you miss her features. She is lifting the baby on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “What about the fathers?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if possible.
“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
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 be a mom.”
Approaches for managing babies with exposure have existed for decades.
The evaluation method was developed in 1975|