Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Eight months pregnant and in severe pain, the expectant mother visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and threw up.
Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had only a brief window to get treated before she needed to go home to get high again. She thought she still had four weeks left to find a way to become sober and give birth.
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 infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
After five days, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – born before term, small but alive.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “simply” stop using. Even her dealer would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The common assumption that her love for her baby would make her stop using only led to deeper self-loathing and negative self-talk, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.
The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would break her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name Izzie, 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 much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to pick her up.
She departed the institution still in recovery, scared and uncertain about what would come next.
At Maddie’s Place, Stephanie still was concerned that CPS would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could walk in and take her baby away.
For the initial fortnight, Stephanie kept to herself. “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.”
Survival outdoors, she said, was about survival. Drugs came first; trust came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She was unable to value herself, let alone anyone else.
Each day, staff from the center transported her to a treatment center, provided orally. Slowly, she was beginning recovery.
She spent every minute outside treatment 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 severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an specialist – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I could do this. I would become a mother.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. An advocate, a mentor, visited with her own five kids in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She holds a picture of the moment. She is clad in casual attire, a cap with a bobble on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her leg for the children to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “Why are there no men?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there given the chance.
“When I have kids,” Jacob said, “I will excel as a father. 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 was able. I would become a mother.”
Tools for treating drug-exposed newborns have been available for years.
The assessment tool was developed in 1975|