Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
Pregnant and experiencing intense discomfort, the expectant mother arrived at the medical facility after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also addicted to fentanyl.
As physicians addressed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and threw up.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had taken the drug before arriving at the hospital and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining to plan her recovery and give birth.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was severe, but physicians found she also had an amniotic fluid leak. The nurse, 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 at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
After five days, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – born before term, tiny yet healthy.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her final administration of fentanyl had been provided shortly before she gave birth.
She felt sick. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery several times during pregnancy, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I needed help.”
The common assumption that her love for her baby would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.
The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would hurt her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the professional who provided support to her.
Hospital staff told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are supported as a unit, not apart.
In much of the US, where a baby is identified with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a small, growing network of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, custody cases decrease and overall savings increase.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to pick her up.
She departed the institution still in withdrawal, fearful and unsure about what would come next.
At the facility, Stephanie still was concerned that authorities would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could arrive and separate them.
For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about getting by. Substances 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.
Every day, staff from the center transported her to a recovery program, administered in pill form. Gradually, she was embracing sobriety.
She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an specialist – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I could do this. I could be a mom.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, visited with her own family in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in admiration of the tiny infant 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 dressed in black pants and a hoodie, a gray knit hat with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her face is downcast so you cannot see her face. She is holding Izzie up on her lap for the other kids to see and they are gathered around, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, called away to other tasks, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could be a mom.”
Approaches for managing babies with exposure have been available for years.
The assessment tool was created in 1975|
