Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
In her eighth month of pregnancy and suffering, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had constructed in a friend’s yard. She was also hooked on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to find a way to become sober and give birth.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, 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 substance abuse treatment.
After five days, on the 12th of November, Stephanie delivered a daughter weighing just over four pounds – premature, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been provided four hours before delivery.
She felt ill. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she failed. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “simply” 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 widespread belief that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a cause 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 baby was taken to the NICU. When Stephanie finally saw her her, she was attached to tubes and leads, so little 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 remained uncertain she wanted to be her mother.
Following a brief period she decided to give her child the name Izzie, after the attendant who showed compassion to her.
Medical personnel told her about a specialized facility, a unique recovery environment where women and their babies are supported as a unit, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, recovery succeeds, 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, a couple of employees came to collect her.
She departed the institution still in withdrawal, scared and uncertain about what would come next.
At the care center, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could walk in and remove her child.
For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about survival. Drugs came first; faith came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to value herself, let alone anyone else.
Each day, staff from Maddie’s Place took her to a treatment center, administered in pill form. Slowly, she was beginning recovery.
She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges 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 parent.
During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own family in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She has an image of the moment. She is wearing black pants and a hoodie, a gray knit hat with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her face is downcast so you do not see her expression. She is lifting the baby on her leg for the children to see and they are standing close, admiring and touching to the baby.
Jacob, eight, asked the mothers: “Where are all the dads?” The parents responded that the men were occupied, handling responsibilities, that they would be there given the chance.
“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I could be a mom.”
Methods to address infants affected by substances have existed for decades.
The Finnegan NAS scale was developed in 1975|
