Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother visited the ER after an infection began spreading up her legs. Without a job or home, separated from loved ones, she lived in a shed she had built in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was serious, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
After five days, on the 12th of November, Stephanie gave birth to a infant weighing just over four pounds – premature, small but alive.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been provided a few hours prior to birth.
She felt unwell. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she relapsed. She felt without value, berating herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The widespread belief that her bond with her newborn would make her quit only led to increased guilt and negative self-talk, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was connected to tubes and leads, so little she thought she would harm her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to give her child the name the same as her nurse, after the attendant who showed compassion to her.
Hospital staff told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like the care home is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to bring her to the facility.
She left the medical center still in recovery, anxious and doubtful about what would happen next.
At Maddie’s Place, Stephanie still was concerned that CPS would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and separate them.
For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about getting by. Addiction came first; trust came last.
Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She did not know how to love herself, let alone anyone else.
Every day, staff from Maddie’s Place took her to a treatment center, given as medication. Slowly, she was embracing sobriety.
She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I was capable. I could parent.
On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” 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 bobble on her head, resting on the floor with the door behind her. She is lean. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the other kids to see and they are crowding near, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there if possible.
“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could be a mom.”
Approaches for managing infants affected by substances have existed for decades.
The Finnegan NAS scale was established in 1975|
