Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother went to the medical facility after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had constructed in a companion's property. She was also dependent on fentanyl.
As medical staff managed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and became sick.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had several weeks to find a way to become sober and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.
After five days, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – premature, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her epidural had failed, her last dose of fentanyl had been provided a few hours prior to birth.
She felt ill. Not ready for motherhood. Unworthy.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, berating herself for not being able to do the impossible. An OBGYN told her to “just” 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 common assumption that her bond with her newborn would make her quit only led to greater shame and self-abuse, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.
The infant was moved to the special care nursery. When Stephanie at last met her, she was hooked up to monitors, so small she thought she would harm her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.
Nurses and doctors told her about a care center, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.
In numerous states, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is showing an important truth: when families are kept intact, results get better, custody cases decrease and long-term costs decline.
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, care providers came to pick her up.
She left the medical center still in recovery, anxious and doubtful about what would come next.
At the facility, Stephanie still was concerned that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could enter and separate them.
For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about survival. Drugs came first; faith came last.
Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to hurt her. She lacked the ability to love herself, not to mention anyone else.
Every day, staff from the facility transported her to a clinic for methadone, provided orally. Slowly, she was embracing sobriety.
She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an professional – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. An advocate, a peer support specialist, came over with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor 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 overlooked my addiction. None of those things mattered to them.”
She keeps a photo of the moment. She is clad in black pants and a hoodie, a beanie with a pompom on her head, seated on the ground with the entryway at her back. She is thin. Her posture is humble so you cannot see her face. She is holding Izzie up on her knee for the other kids to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I could parent.”
Methods to address babies with exposure have been available for years.
The Finnegan NAS scale was created in 1975|
