Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, a woman named Stephanie visited the ER after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had assembled in a companion's property. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she needed to go home to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.
After five days, on the 12th of November, Stephanie gave birth to a baby girl weighing 4lb 8oz – born before term, small but alive.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her dealer declined to supply to her when she became clearly expecting.
“Yet I was unable,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her stop using only led to increased guilt and negative self-talk, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the attendant who showed compassion to her.
Hospital staff told her about a care center, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.
It took Stephanie a period to find strength to call, but she eventually made the call. 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 withdrawal, scared and uncertain about what would follow.
At Maddie’s Place, Stephanie still was concerned that CPS would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could walk in and separate them.
For the initial fortnight, Stephanie kept to herself. “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 survival. Drugs came first; trust came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to hurt her. She did not know how to care for herself, let alone anyone else.
Daily, staff from the center drove her to a clinic for methadone, administered in pill form. Slowly, she was embracing sobriety.
She utilized each moment beyond therapy 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 obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an specialist – all typical problems for babies affected by withdrawal.
When a child recognizes these infants need affection, then I was capable. I would become a mother.
On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a recovery coach, came over with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration 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 wearing casual attire, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is thin. Her head is tilted forward so you miss her features. She is presenting her daughter on her knee for the other kids to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could be a mom.”
Tools for treating drug-exposed newborns have been available for years.
The evaluation method was created in 1975|
