Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
Eight months pregnant and in severe pain, a woman named Stephanie went to the hospital emergency room after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also hooked on fentanyl.
As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before seeking medical help and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had several weeks to plan her recovery and give birth.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“Yes, I am,” 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, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.
A short time later, on a day in November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – born before term, small but alive.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was numb. Her pain relief did not work, her final administration of fentanyl had been given shortly before she gave birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, berating herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became obviously with child.
“However, I failed,” she said. “I required assistance.”
The widespread belief that her affection for her child would make her quit only led to greater shame and negative self-talk, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to monitors, so tiny she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What is our future?’” 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 professional who provided support to her.
Hospital staff told her about a specialized facility, a innovative treatment home where women and their babies are treated together, not apart.
In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is showing an important truth: when families are kept intact, outcomes improve, foster placements fall and future expenses reduce.
It took Stephanie some time to build confidence 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 left the medical center still in detox, fearful and unsure about what would come next.
At the care center, Stephanie still was concerned that CPS would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and remove her child.
For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about enduring. Substances came first; trust came last.
Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She lacked the ability to love herself, much less anyone else.
Every day, staff from Maddie’s Place transported her to a recovery program, provided orally. Over time, she was beginning recovery.
She spent every minute 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 intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
During a pre-holiday visit, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a decoration on her head, resting on the floor with the entryway at her back. She is lean. Her posture is humble so you cannot see her face. She is holding Izzie up on her lap for the other kids to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there if they could.
“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could parent.”
Methods to address drug-exposed newborns have existed for decades.
The evaluation method was established in 1975|
