Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie went to the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was severe, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.
After five days, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – premature, small but alive.
When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was detached. Her pain relief did not work, her final administration of fentanyl had been provided four hours before delivery.
She felt sick. Ill-equipped for parenting. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she was unsuccessful. She felt worthless, berating herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her supplier refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I needed help.”
The widespread belief that her love for her baby would make her stop using only led to greater shame and self-abuse, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.
The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was connected to monitors, so tiny she thought she would harm her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to name her baby Izzie, after the professional who provided support to her.
Nurses and doctors told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is identified with newborn addiction symptoms 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 demonstrating a key fact: when families are kept intact, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a while to gather the courage 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 recovery, anxious and doubtful about what would come next.
At the facility, Stephanie still worried that child services would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and separate them.
For the initial fortnight, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about getting by. Addiction 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 was unable to value herself, let alone anyone else.
Daily, staff from the center transported her to a clinic for methadone, provided orally. Slowly, she was beginning recovery.
She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an specialist – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
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. A support specialist, a mentor, came over with her own five kids in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The young ones stared in wonder 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. Such issues were irrelevant.”
She has an image of the moment. She is clad in casual attire, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is thin. Her posture is humble so you miss her features. She is lifting the baby on her leg for the young ones to see and they are standing close, admiring and touching to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if they could.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I would become a mother.”
Methods to address babies with exposure have existed for decades.
The evaluation method was developed in 1975|