Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother visited the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She slumped forward and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”
She had taken the drug before seeking medical help and had only a brief window to get treated before she had to return to use once more. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I am leaving,” 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, Izzie, warned her: if she left, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.
After five days, on 12 November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – premature, small but alive.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.
She felt ill. Ill-equipped for parenting. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her source would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I needed help.”
The pervasive expectation that her love for her baby would make her recover only led to greater shame and self-harm, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.
The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby after her caregiver, after the professional who provided support to her.
Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.
In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals 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, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to collect her.
She departed the institution still in withdrawal, fearful and unsure about what would come next.
At Maddie’s Place, Stephanie still was concerned that authorities would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could enter and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about enduring. Addiction came first; trust came last.
Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She lacked the ability to care for herself, not to mention anyone else.
Each day, staff from the center transported her to a recovery program, provided orally. Slowly, she was embracing sobriety.
She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I could do this. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. A support specialist, a peer support specialist, stopped by with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is clad in 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 do not see her expression. She is lifting the baby on her leg for the young ones to see and they are standing close, fawning and reaching out to the baby.
Jacob, eight, asked the parents: “Why are there no men?” The parents responded that the men were occupied, handling responsibilities, that they would be there if they could.
“In the future,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”
Tools for treating infants affected by substances have been available for years.
The evaluation method was established in 1975|
