Fentanyl Addiction During Pregnancy: How Keeping Her Baby Rescued Both Lives.
Eight months pregnant and in severe pain, the expectant mother went to the ER after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl 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 four weeks left to find a way to become sober and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
After five days, on a day in November 2022, Stephanie had a infant weighing 4lb 8oz – premature, tiny yet healthy.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her epidural had failed, her last dose of fentanyl had been provided a few hours prior to birth.
She felt unwell. Ill-equipped for parenting. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her source would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her quit only led to greater shame and negative self-talk, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the NICU. When Stephanie eventually visited her, she was hooked up to tubes and leads, so small she thought she would harm her. Embracing her at last, she felt empty. “I looked 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 give her child the name 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 supported as a unit, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face parental assessments. But a limited but expanding group of centers like the care home is showing an important truth: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, care providers came to collect her.
She departed the institution still in withdrawal, scared and uncertain about what would come next.
At the facility, Stephanie still worried that CPS would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could walk in and take her baby away.
For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about enduring. Substances came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to cause pain. She did not know how to love herself, not to mention anyone else.
Daily, staff from the facility took her to a treatment center, given as medication. Slowly, she was embracing sobriety.
She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an professional – all common issues 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.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a peer support specialist, visited with her own family in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She has an image of the moment. She is dressed in black pants and a hoodie, 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 do not see her expression. She is holding Izzie up on her leg for the other kids to see and they are standing close, admiring and touching to the baby.
One child, eight, asked the moms: “Why are there no men?” The parents responded that the dads were busy, engaged elsewhere, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.”
Approaches for managing babies with exposure have been available for years.
The Finnegan NAS scale was created in 1975|
