Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie visited the ER after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had constructed in a companion's property. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and threw up.
Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids before seeking medical help and had only a brief window to get treated before she needed to go home to relapse. She thought she still had four weeks left to figure out how to get clean and deliver her child.
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 severe, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie had a daughter weighing 4lb 8oz – born before term, little but surviving.
When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she was unsuccessful. She felt hopeless, berating herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her source declined to supply to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The widespread belief that her affection for her child would make her recover only led to deeper self-loathing and negative self-talk, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to medical equipment, so little she thought she would hurt her. Cradling her initially, 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 after her caregiver, after the attendant who showed compassion to her.
Medical personnel told her about a care center, a unique recovery environment where women and their babies are treated together, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like the care home is proving a simple point: when parents and infants remain united, results get better, custody cases decrease and overall savings increase.
It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to bring her to the facility.
She departed the institution still in withdrawal, scared and uncertain about what would follow.
At the facility, Stephanie still worried that authorities would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could arrive and take her baby away.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about enduring. Addiction came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to care for herself, not to mention anyone else.
Every day, staff from the center took her to a clinic for methadone, provided orally. Slowly, she was beginning recovery.
She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an specialist – all common issues for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie was in the common room, where those still using can come for guided meetings with their babies. An advocate, a mentor, stopped by with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The young ones stared in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a gray knit hat with a decoration on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you miss her features. She is holding Izzie up 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 moms: “Where are all the dads?” The parents responded 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 plan to be a great parent. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could parent.”
Tools for treating babies with exposure have been available for years.
The evaluation method was developed in 1975|
