Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie went to the ER after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and vomited.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”
She had used fentanyl 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 have this baby.
The medical professional intervened. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was critical, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger 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 gave birth to a baby girl weighing just over four pounds – early, tiny yet healthy.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her epidural had failed, her final administration of fentanyl had been administered four hours before delivery.
She felt sick. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her source refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her recover only led to greater shame and negative self-talk, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.
The baby was taken to the special care nursery. When Stephanie at last met her, she was attached to monitors, so small she thought she would harm her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like the care home is demonstrating a key fact: when mothers and babies stay together, outcomes improve, foster placements fall and overall savings increase.
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 pick her up.
She departed the institution still in withdrawal, fearful and unsure about what would happen next.
At Maddie’s Place, Stephanie still worried that CPS would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could enter and separate them.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about getting by. Drugs came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to hurt her. She lacked the ability to care for herself, much less anyone else.
Each day, staff from the center took her to a treatment center, provided orally. Gradually, she was beginning recovery.
She spent every minute 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 adverse reactions to milk and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an professional – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I found the strength. 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 monitored interactions with their babies. Katie Bunch-Smith, a mentor, came over with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She keeps a photo of the moment. She is clad 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 face is downcast so you do not see her expression. She is presenting her daughter on her lap for the young ones to see and they are crowding near, fawning and reaching out to the baby.
One child, eight, asked the moms: “What about the fathers?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could parent.”
Tools for treating drug-exposed newborns have been available for years.
The assessment tool was created in 1975|
