Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
In her eighth month of pregnancy and suffering, the expectant mother visited the medical facility after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. 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 used fentanyl before seeking medical help and had just enough time to get treated before she had to return to relapse. She thought she still had a month remaining to figure out how to get clean and have this baby.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was serious, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.
After five days, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – early, tiny yet healthy.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt sick. Ill-equipped for parenting. Not fit.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she was unsuccessful. She felt worthless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her dealer 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 affection for her child would make her quit only led to increased guilt and negative self-talk, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The infant was moved to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so tiny she thought she would hurt her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to name her baby after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about a specialized facility, a unique recovery environment where women and their babies are treated together, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like this facility is proving a simple point: when parents and infants remain united, results get better, foster placements fall and future expenses reduce.
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 departed the institution still in withdrawal, scared and uncertain about what would happen 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 point, someone could walk in and take her baby away.
For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about enduring. Drugs came first; trust came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to love herself, much less anyone else.
Each day, staff from Maddie’s Place drove her to a recovery program, administered in pill form. Over time, she was beginning recovery.
She devoted all her time beyond therapy 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 obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an professional – all common issues for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
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. A support specialist, a mentor, visited with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is dressed in casual attire, a gray knit hat with a decoration 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 holding Izzie up on her lap for the children to see and they are standing close, admiring and touching to the baby.
Jacob, eight, asked the moms: “Where are all the dads?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” 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 broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I would become a mother.”
Approaches for managing drug-exposed newborns have been used for a long time.
The evaluation method was created in 1975|
