Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie visited the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had built in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and threw up.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to relapse. She thought she still had several weeks to find a way to become sober and have this baby.
The medical professional intervened. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
A short time later, on the 12th of November, Stephanie had a infant weighing a small weight – premature, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her epidural had failed, her previous intake of fentanyl had been provided four hours before delivery.
She felt unwell. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her love for her baby would make her stop using only led to increased guilt and self-abuse, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to tubes and leads, so small she thought she would harm her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Two days later she decided to name her baby the same as her nurse, after the professional who provided support to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is demonstrating a key fact: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, care providers came to bring her to the facility.
She departed the institution still in recovery, fearful and unsure about what would follow.
At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any time, someone could arrive and remove her child.
For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about enduring. Substances came first; trust came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She was unable to care for herself, let alone anyone else.
Every day, staff from the center drove her to a treatment center, administered in pill form. Slowly, she was beginning recovery.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I was capable. I would become a mother.
One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a peer support specialist, visited with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
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 exit nearby. She is thin. Her face is downcast so you cannot see her face. She is lifting the baby on her leg for the children to see and they are standing close, admiring and touching to the baby.
One child, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I would become a mother.”
Methods to address drug-exposed newborns have existed for decades.
The Finnegan NAS scale was created in 1975|
