Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading 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 physicians addressed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and threw up.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to find a way to become sober and deliver her child.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the doctors would not let her go: the infection in her legs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, 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 often prescribed in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – born before term, little but surviving.
When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.
She felt ill. Not ready for motherhood. Unworthy.
Stephanie had sought recovery multiple times while expecting, and felt awful each time she was unsuccessful. She felt without value, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“But I couldn’t,” she said. “I needed help.”
The widespread belief that her love for her baby would make her recover only led to increased guilt and negative self-talk, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.
Nurses and doctors told her about a specialized facility, a innovative treatment home 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) every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, recovery succeeds, foster placements fall 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 stepped out of the hospital still in recovery, scared and uncertain about what would follow.
At the care center, Stephanie still feared that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could walk in and separate them.
For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about enduring. Drugs came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to let her down. She was unable to value herself, not to mention anyone else.
Daily, staff from Maddie’s Place took her to a clinic for methadone, administered in pill form. Gradually, she was beginning recovery.
She devoted all her time outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an professional – all typical problems for babies born with NAS.
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 was in the common room, where parents in active addiction can come for guided meetings with their babies. A support specialist, a recovery coach, visited with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She keeps a photo of the moment. She is wearing casual attire, a gray knit hat with a decoration on her head, resting on the floor with the exit nearby. She is slender. Her posture is humble so you miss her features. She is lifting the baby on her knee for the young ones to see and they are crowding near, showing interest to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could parent.”
Methods to address infants affected by substances have been used for a long time.
The Finnegan NAS scale was established in 1975|
