Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother arrived at the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also hooked on fentanyl.
As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to use once more. 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.
“I will go,” Stephanie said.
But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.
A short time later, on the 12th of November, Stephanie delivered a baby girl weighing 4lb 8oz – early, tiny yet healthy.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her previous intake of fentanyl had been provided four hours before delivery.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she failed. She felt without value, blaming herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her dealer would not provide to her when she became obviously with child.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her quit only led to greater shame and negative self-talk, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was attached to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to name her baby after her caregiver, 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 found to have infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.
It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to pick her up.
She stepped out of the hospital still in recovery, scared and uncertain about what would follow.
At Maddie’s Place, Stephanie still was concerned that authorities would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could walk in and remove her child.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about survival. Addiction came first; reliance 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 did not know how to care for herself, not to mention anyone else.
Daily, staff from the center transported her to a recovery program, administered in pill form. Slowly, she was beginning recovery.
She devoted all her time 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 obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. A support specialist, a mentor, stopped by with her own family in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The young ones stared in awe 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. Such issues were irrelevant.”
She has an image of the moment. She is clad in casual attire, a beanie with a bobble on her head, resting on the floor with the door behind her. She is thin. Her face is downcast so you miss her features. She is presenting her daughter on her leg for the children to see and they are crowding near, showing interest to the baby.
One child, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could be a mom.”
Methods to address drug-exposed newborns have existed for decades.
The assessment tool was developed in 1975|
