She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, the expectant mother arrived at the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had constructed in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and became sick.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had four weeks left to figure out how to get clean and give birth.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
A short time later, on the 12th of November, Stephanie had a daughter weighing a small weight – early, tiny yet healthy.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her pain relief did not work, her final administration of fentanyl had been provided four hours before delivery.
She felt sick. Not ready for motherhood. Unworthy.
Stephanie had sought recovery several times during pregnancy, and felt terrible each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her source would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The pervasive expectation that her love for her baby would make her quit only led to increased guilt and self-abuse, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The infant was moved to the special care nursery. When Stephanie eventually visited her, she was connected to monitors, so little she thought she would break her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Two days later she decided to name her baby the same as her nurse, after the nurse who had been so kind 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 cared for jointly, not apart.
In much of the US, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, outcomes improve, foster placements fall and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to collect her.
She stepped out of the hospital still in detox, fearful and unsure about what would happen next.
At the facility, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and remove her child.
For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about enduring. Substances came first; faith came last.
Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to let her down. She did not know how to love herself, not to mention anyone else.
Every day, staff from the facility drove her to a clinic for methadone, administered in pill form. Over time, she was starting to get clean.
She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all common issues for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I would become a mother.
On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. A support specialist, a recovery coach, stopped by with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a bobble on her head, sitting on the wooden floor with the door behind her. She is lean. Her head is tilted forward so you miss her features. She is presenting her daughter on her knee for the other kids to see and they are standing close, admiring and touching to the baby.
One child, 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 possible.
“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could be a mom.”
Approaches for managing babies with exposure have existed for decades.
The Finnegan NAS scale was developed in 1975|
