She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, the expectant mother went to the medical facility after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had assembled in a friend’s yard. She was also hooked on fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”
She had used fentanyl before seeking medical help and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had several weeks to plan her recovery and have this baby.
The medical professional intervened. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was severe, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, 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. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.
After five days, on the 12th of November, Stephanie gave birth to a infant weighing just over four pounds – early, little but surviving.
When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her supplier declined to supply to her when she became visibly pregnant.
“However, I failed,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her stop using only led to increased guilt and self-abuse, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The infant was moved to the NICU. When Stephanie finally saw her her, she was hooked up to tubes and leads, so small she thought she would break her. Embracing her at last, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter Izzie, after the attendant who showed compassion to her.
Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when families are kept intact, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to collect her.
She departed the institution still in withdrawal, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could arrive and remove her child.
For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about enduring. Addiction came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to cause pain. She was unable to care for herself, not to mention anyone else.
Each day, staff from the facility drove her to a recovery program, given as medication. Gradually, she was beginning recovery.
She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. An advocate, a mentor, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in wonder of the little newborn 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 holds a picture of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a decoration on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her lap for the children to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.”
Approaches for managing drug-exposed newborns have been used for a long time.
The Finnegan NAS scale was established in 1975|
