She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before seeking medical help and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to plan her recovery and deliver her child.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
She encouraged 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 transitioned to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.
After five days, on a day in November 2022, Stephanie delivered a infant weighing just over four pounds – born before term, tiny yet healthy.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given a few hours prior to birth.
She felt ill. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she relapsed. She felt worthless, criticizing herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her dealer refused to sell to her when she became clearly expecting.
“However, I failed,” she said. “I needed help.”
The widespread belief that her affection for her child would make her stop using only led to greater shame and negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.
The infant was moved to the special care nursery. When Stephanie at last met her, she was connected to medical equipment, so tiny she thought she would harm her. Embracing her at last, she felt detached. “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 the same as her nurse, after the nurse who had been so kind to her.
Hospital staff told her about Maddie’s Place, a new kind of care center where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like this facility is proving a simple point: when families are kept intact, results get better, foster placements fall and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to bring her to the facility.
She stepped out of the hospital still in recovery, fearful and unsure about what would come next.
At the facility, Stephanie still worried that child services would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could walk in and take her baby away.
For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Homelessness, she said, was about enduring. Drugs came first; faith came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to care for herself, let alone anyone else.
Every day, staff from Maddie’s Place took her to a clinic for methadone, given as medication. Slowly, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an specialist – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.
On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own family in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She keeps a photo of the moment. She is wearing casual attire, a cap with a bobble on her head, sitting on the wooden floor with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her knee for the other kids to see and they are standing close, admiring and touching to the baby.
A young boy, eight, asked the parents: “What about the fathers?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could parent.”
Approaches for managing infants affected by substances have been available for years.
The Finnegan NAS scale was developed in 1975|
