Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother went to the ER after her infection worsened up her legs. Without a job or home, estranged from her family, she resided in a small structure she had constructed 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 slumped forward and became sick.
Stephanie ultimately gave in. “Listen, I gotta go. 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 get high again. She thought she still had a month remaining to figure out how to get clean and give birth.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the leg infection was critical, 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 not survive.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in addiction recovery.
Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing a small weight – born before term, little but surviving.
When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been given four hours before delivery.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she was unsuccessful. She felt worthless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her bond with her newborn would make her recover only led to increased guilt and self-harm, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The baby was taken to the special care nursery. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would break her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the attendant who showed compassion to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to pick her up.
She departed the institution still in withdrawal, fearful and unsure about what would come next.
At the facility, Stephanie still worried that child services would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could walk in and remove her child.
For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about getting by. Drugs came first; trust came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to care for herself, let alone anyone else.
Each day, staff from the facility took her to a treatment center, provided orally. Over time, she was starting to get clean.
She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an specialist – all common issues 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 sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. An advocate, a mentor, stopped by with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She has an image of the moment. She is clad in dark trousers and a sweatshirt, a cap with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her face is downcast so you cannot see her face. She is holding Izzie up on her leg for the young ones to see and they are crowding near, showing interest to the baby.
One child, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”
Approaches for managing infants affected by substances have existed for decades.
The Finnegan NAS scale was created in 1975|
