Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”
She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had several weeks to find a way to become sober and have this baby.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
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 hold her baby, Stephanie said “I cannot.” She was detached. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she relapsed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The widespread belief that her love for her baby would make her quit only led to increased guilt and self-abuse, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was attached to monitors, so small she thought she would break her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the nurse who had been so kind to her.
Medical personnel told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, recovery succeeds, fewer children enter care and overall savings increase.
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 pick her up.
She stepped out of the hospital still in recovery, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still was concerned that CPS would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any point, someone could arrive and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about enduring. Substances came first; reliance came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to let her down. She lacked the ability to care for herself, let alone anyone else.
Every day, staff from Maddie’s Place drove her to a treatment center, provided orally. Slowly, she was starting to get clean.
She devoted all her time 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 intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues 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 be a mom.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is clad in casual attire, a gray knit hat with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her face is downcast so you do not see her expression. She is presenting her daughter on her lap for the young ones to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if they could.
“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could parent.”
Methods to address babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
