Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the ER after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had assembled in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had several weeks to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
The nurse convinced 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 transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
Five days later, on a day in November 2022, Stephanie had a daughter weighing a small weight – early, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been given four hours before delivery.
She felt ill. Not ready for motherhood. Unworthy.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier declined to supply to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her affection for her child would make her quit only led to deeper self-loathing and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.
The infant was moved to the NICU. When Stephanie eventually visited her, she was connected to medical equipment, so tiny she thought she would hurt her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In numerous states, where a baby is found to have infant withdrawal condition regularly, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a small, growing network of centers like the care home is proving a simple point: when mothers and babies stay together, outcomes improve, fewer children enter care and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to collect her.
She departed the institution still in withdrawal, fearful and unsure about what would happen next.
At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could arrive and separate them.
For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about enduring. Addiction 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 let her down. She was unable to love herself, let alone anyone else.
Daily, staff from the facility drove her to a treatment center, provided orally. Gradually, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I could do this. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. A support specialist, a mentor, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She holds a picture of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the children to see and they are crowding near, admiring and touching to the baby.
One child, eight, asked the moms: “What about the fathers?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if possible.
“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could parent.”
Methods to address infants affected by substances have been available for years.
The evaluation method was created in 1975|
