Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie visited the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had constructed in a companion's property. She was also hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
Five days later, on the 12th of November, Stephanie gave birth to a daughter weighing 4lb 8oz – born before term, tiny yet healthy.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she relapsed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her bond with her newborn would make her quit only led to greater shame and self-harm, a trigger 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 neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to monitors, so little she thought she would harm her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Medical personnel told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In numerous states, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to pick her up.
She left the medical center still in withdrawal, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still feared that CPS would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could enter and remove her child.
For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about survival. Substances came first; reliance came last.
Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She did not know how to love herself, much less anyone else.
Daily, staff from the facility transported her to a recovery program, given as medication. Over time, she was starting to get clean.
She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. 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 found the strength. I could be a mom.
On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a mentor, visited with her own children in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration of the small baby 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 casual attire, a gray knit hat with a bobble on her head, resting on the floor with the door behind her. She is thin. Her head is tilted forward so you miss her features. She is presenting her daughter on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could be a mom.”
Approaches for managing drug-exposed newborns have been available for years.
The assessment tool was developed in 1975|
