Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Eight months pregnant and in severe pain, the expectant mother went to the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had built in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and became sick.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”
She had taken the drug before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had several weeks to find a way to become sober and give birth.
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 infection in her legs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
After five days, on a day in November 2022, Stephanie had a infant weighing just over four pounds – born before term, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.
She felt ill. Not ready for motherhood. Unworthy.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she failed. She felt without value, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I needed help.”
The pervasive expectation that her affection for her child would make her stop using only led to increased guilt and self-abuse, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was hooked up to monitors, so small she thought she would harm her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to call her daughter the same as her nurse, after the nurse who had been so kind to her.
Medical personnel told her about a specialized facility, a new kind of care center where women and their babies are supported as a unit, not apart.
In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like this facility 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 ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to collect her.
She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.
At the facility, Stephanie still worried that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and remove her child.
For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about getting by. 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 cause pain. She was unable to care for herself, much less anyone else.
Each day, staff from Maddie’s Place drove her to a clinic for methadone, provided orally. Over time, she was embracing sobriety.
She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an professional – all typical problems for babies born with NAS.
Seeing that even a young person understands the need for care, then I could do this. I would become a mother.
During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, came over with her own family in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a gray knit hat with a bobble on her head, sitting on the wooden floor with the door behind her. She is thin. Her face is downcast so you miss her features. She is lifting the baby on her knee for the other kids to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the moms: “What about the fathers?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and the specialist looked at each other. “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.”
Approaches for managing infants affected by substances have been available for years.
The Finnegan NAS scale was established in 1975|
