She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
In her eighth month of pregnancy and suffering, a woman named Stephanie went to the medical facility after an infection began spreading 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 hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and became sick.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids 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 plan her recovery and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.
After five days, on the 12th of November, Stephanie gave birth to a daughter weighing 4lb 8oz – born before term, little but surviving.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had sought recovery multiple times while expecting, and felt horrible each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier would not provide to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The common assumption that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was attached to medical equipment, so little she thought she would harm her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to call her daughter the same as her nurse, after the nurse who had been so kind to her.
Hospital staff told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.
In much of the US, where a baby is diagnosed 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 limited but expanding group of centers like this facility is showing an important truth: when mothers and babies stay together, outcomes improve, custody cases decrease and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to pick her up.
She stepped out of the hospital still in detox, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still worried that CPS would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could arrive and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Substances came first; reliance came last.
Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to let her down. She lacked the ability to love herself, not to mention anyone else.
Daily, staff from Maddie’s Place transported her to a treatment center, provided orally. Slowly, she was embracing sobriety.
She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own children in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. 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, seated on the ground with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her knee for the children to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the parents: “Why are there no men?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could parent.”
Approaches for managing drug-exposed newborns have been available for years.
The evaluation method was developed in 1975|
