Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother visited the ER after her infection worsened up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a acquaintance's garden. 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 threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she needed to go home to relapse. She thought she still had four weeks left to plan her recovery and give birth.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the leg infection was critical, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing a small weight – early, tiny yet healthy.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given a few hours prior to birth.
She felt sick. Ill-equipped for parenting. Unworthy.
Stephanie had tried to get clean several times during pregnancy, and felt awful each time she failed. She felt without value, blaming herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her source refused to sell to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The pervasive expectation that her love for her baby would make her quit only led to increased guilt and self-harm, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The baby was taken to the NICU. When Stephanie at last met her, she was connected to medical equipment, so small she thought she would break her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a new kind of care center where women and their babies are treated together, not apart.
In numerous states, where a baby is found to have infant withdrawal condition regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, foster placements fall and future expenses reduce.
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 left the medical center still in recovery, scared and uncertain about what would follow.
At the care center, Stephanie still was concerned that child services would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could walk in and separate them.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Addiction came first; reliance 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 lacked the ability to love herself, let alone anyone else.
Each day, staff from Maddie’s Place took her to a clinic for methadone, administered in pill form. Gradually, she was beginning recovery.
She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, came over with her own children in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, seated on the ground with the exit nearby. 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 gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “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 possible.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”
Methods to address babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
