A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and became sick.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she had to return to get high again. She thought she still had several weeks to find a way to become sober and deliver her child.
The nurse had other ideas. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, 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 addiction recovery.
After five days, on a day in November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – born before term, small but alive.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.
She felt ill. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she relapsed. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I needed help.”
The pervasive expectation that her love for her baby would make her stop using only led to greater shame and negative self-talk, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are cared for jointly, not apart.
In numerous states, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and long-term costs decline.
It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She left the medical center still in withdrawal, scared and uncertain about what would happen next.
At the facility, Stephanie still worried that child services would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could enter and separate them.
For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about getting by. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to cause pain. She lacked the ability to care for herself, much less anyone else.
Each day, staff from Maddie’s Place transported her to a recovery program, administered in pill form. Gradually, she was starting to get clean.
She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all common issues 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.
During a pre-holiday visit, Stephanie was in the common room, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She holds a picture of the moment. She is clad in black pants and a hoodie, a beanie with a bobble on her head, resting on the floor with the exit nearby. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the young ones to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I could be a mom.”
Approaches for managing babies with exposure have existed for decades.
The Finnegan NAS scale was developed in 1975|
