Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the medical facility after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had assembled in a companion's property. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and threw up.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids before seeking medical help and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The attending nurse disagreed. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was critical, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.
A short time later, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – born before term, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.
She felt sick. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery multiple times while expecting, and felt terrible each time she was unsuccessful. She felt worthless, berating herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her supplier declined to supply to her when she became visibly pregnant.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her stop using only led to increased guilt and self-harm, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to tubes and leads, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘What is our future?’” She continued to doubt 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 unique recovery environment where women and their babies are treated together, not apart.
In numerous states, where a baby is identified with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, recovery succeeds, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to pick her up.
She left the medical center still in recovery, fearful and unsure about what would happen next.
At the care center, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and take her baby away.
For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about enduring. Substances came first; faith came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She did not know how to value herself, let alone anyone else.
Every day, staff from Maddie’s Place drove her to a clinic for methadone, provided orally. Gradually, 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 typical problems for babies born with NAS.
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 was in the common room, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, came over 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 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. None of those things mattered to them.”
She has an image of the moment. She is wearing black pants and a hoodie, a cap with a bobble on her head, sitting on the wooden floor with the door behind her. She is slender. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her lap for the young ones to see and they are crowding near, fawning and reaching out to the baby.
Jacob, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the men were occupied, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I was able. I would become a mother.”
Methods to address drug-exposed newborns have existed for decades.
The evaluation method was developed in 1975|
