Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had built in a friend’s yard. She was also hooked on fentanyl.
As physicians addressed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had four weeks left 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 hospital refused to discharge her: the leg infection was critical, 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 face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger 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 addiction recovery.
After five days, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – born before term, small but alive.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she was unsuccessful. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would break her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the professional who provided support to her.
Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is identified with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a developing system of centers like the care home is proving a simple point: when mothers and babies stay together, recovery succeeds, foster placements fall and future expenses reduce.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to bring her to the facility.
She stepped out of the hospital still in detox, fearful and unsure 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 remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about survival. Substances came first; trust came last.
Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to cause pain. She was unable to love herself, much less anyone else.
Daily, staff from the center drove her to a treatment center, given as medication. Gradually, she was embracing sobriety.
She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies born with NAS.
Seeing that even a young person understands the need for care, then I could do this. I would become a mother.
During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, stopped by with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The young ones stared in awe of the tiny infant 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 keeps a photo of the moment. She is clad in casual attire, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is lean. Her face is downcast so you do not see her expression. She is presenting her daughter on her lap for the other kids to see and they are gathered around, admiring and touching to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the men were occupied, 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 exchanged glances. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I would become a mother.”
Tools for treating drug-exposed newborns have been available for years.
The evaluation method was developed in 1975|
