She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.
In her eighth month of pregnancy and suffering, a woman named Stephanie went to the medical facility after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had a month remaining to find a way to become sober and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was critical, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.
Five days later, on the 12th of November, Stephanie had a infant weighing just over four pounds – early, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her last dose of fentanyl had been provided a few hours prior to birth.
She felt sick. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery multiple times while expecting, and felt terrible each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her supplier declined to supply to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The common assumption that her affection for her child would make her stop using 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 overcome a long-term illness.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would harm her. Embracing her at last, 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.
After two days she decided to give her child the name Izzie, after the attendant who showed compassion to her.
Medical personnel told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to pick her up.
She departed the institution still in withdrawal, anxious and doubtful about what would happen next.
At the facility, Stephanie still worried that CPS would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could enter and remove her child.
For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” 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 bond was fragile. The individuals she cared for always found ways to let her down. She did not know how to love herself, not to mention anyone else.
Every day, staff from Maddie’s Place took her to a clinic for methadone, provided orally. Slowly, she was beginning recovery.
She devoted all her time outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all typical problems for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.
During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a pompom on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her knee for the other kids to see and they are gathered around, showing interest to the baby.
One child, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could parent.”
Methods to address babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
