She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at the ER after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”
She had used fentanyl before seeking medical help and had just enough time to get treated before she had to return to relapse. She thought she still had several weeks to plan her recovery and have this baby.
The medical professional intervened. 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 doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
Five days later, on a day in November 2022, Stephanie had a daughter weighing just over four pounds – born before term, tiny yet healthy.
When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been provided four hours before delivery.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her dealer declined to supply to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her affection for her child would make her quit only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.
The baby was taken to the NICU. When Stephanie finally saw her her, she was hooked up to medical equipment, so little she thought she would break her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.
Hospital staff told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.
In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a developing system of centers like this facility is showing an important truth: when families are kept intact, results get better, fewer children enter care and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, two staff members came to collect her.
She left the medical center still in withdrawal, scared and uncertain about what would follow.
At the facility, Stephanie still worried that CPS would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any point, someone could walk in and separate them.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about survival. Addiction came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She did not know how to care for herself, let alone anyone else.
Each day, staff from the center transported her to a treatment center, provided orally. Gradually, she was embracing sobriety.
She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I found the strength. I could be a mom.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. A support specialist, a recovery coach, came over with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the small baby 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 holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a bobble on her head, resting on the floor with the door behind her. She is thin. Her posture is humble so you do not see her expression. She is holding Izzie up on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist looked at each other. “I broke down,” 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 babies with exposure have existed for decades.
The assessment tool was created in 1975|
