Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, the expectant mother went to the ER after her infection worsened up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had built in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to plan her recovery and give birth.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.
After five days, on a day in November 2022, Stephanie delivered a daughter weighing 4lb 8oz – born before term, small but alive.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she relapsed. She felt hopeless, criticizing herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The common assumption that her affection for her child would make her quit only led to deeper self-loathing and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was connected to monitors, so tiny she thought she would harm her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to call her daughter Izzie, after the professional who provided support to her.
Medical personnel told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) 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 proving a simple point: when mothers and babies stay together, recovery succeeds, fewer children enter care and overall savings increase.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, care providers came to collect her.
She stepped out of the hospital still in withdrawal, scared and uncertain about what would follow.
At the facility, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any point, someone could arrive and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about survival. Drugs came first; trust 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 did not know how to care for herself, much less anyone else.
Daily, staff from Maddie’s Place took her to a clinic for methadone, provided orally. Gradually, she was beginning recovery.
She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an specialist – all frequent conditions for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She has an image of the moment. She is wearing black pants and a hoodie, a beanie with a pompom on her head, seated on the ground with the door behind her. She is thin. Her posture is humble so you miss her features. She is presenting her daughter on her lap for the young ones to see and they are standing close, admiring and touching to the baby.
A young boy, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” 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 looked at each other. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could be a mom.”
Approaches for managing infants affected by substances have existed for decades.
The assessment tool was established in 1975|
