Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, the expectant mother arrived at the ER after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she had to return to relapse. She thought she still had four weeks left to figure out how to get clean and have this baby.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.
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 placed on methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been given shortly before she gave birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she failed. She felt hopeless, berating herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her dealer refused to sell to her when she became clearly expecting.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her quit only led to greater shame and self-harm, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.
Medical personnel told her about a care center, a innovative treatment home where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like this facility is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and long-term costs decline.
It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to pick her up.
She left the medical center still in withdrawal, anxious and doubtful about what would happen next.
At the care center, Stephanie still was concerned that CPS would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could walk in and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. 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 let her down. She did not know how to value herself, let alone anyone else.
Each day, staff from the facility took her to a treatment center, administered in pill form. Slowly, she was embracing sobriety.
She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies exposed to substances.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. A support specialist, a recovery coach, stopped by with her own children in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She keeps a photo of the moment. She is dressed in casual attire, a gray knit hat with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her face is downcast so you cannot see her face. She is lifting the baby on her leg for the young ones to see and they are crowding near, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I would become a mother.”
Methods to address drug-exposed newborns have existed for decades.
The assessment tool was developed in 1975|
