Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother went to the ER after her infection worsened up her legs. Without a job or home, estranged from her family, she resided in a small structure she had built in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”
She had used fentanyl before arriving at the hospital and had just enough time to get treated before she had to return 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 allowed to leave.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was severe, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing 4lb 8oz – born before term, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been administered four hours before delivery.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she relapsed. She felt hopeless, berating herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and negative self-talk, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was attached to monitors, so small she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
After two days she decided to call her daughter Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is showing an important truth: when families are kept intact, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, care providers came to collect her.
She left the medical center still in detox, fearful and unsure about what would happen next.
At the facility, Stephanie still feared that CPS would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could arrive and take her baby away.
For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to let her down. She was unable to care for herself, not to mention anyone else.
Daily, staff from Maddie’s Place took her to a recovery program, provided orally. Slowly, she was starting to get clean.
She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all typical problems for babies affected by withdrawal.
When a child recognizes these infants need affection, then I found the strength. I would become a mother.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a peer support specialist, visited with her own five kids in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a decoration on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her lap for the young ones to see and they are standing close, fawning and reaching out to the baby.
One child, eight, asked the parents: “Why are there no men?” 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 will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.”
Methods to address infants affected by substances have existed for decades.
The assessment tool was developed in 1975|
