She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had built in a friend’s yard. She was also hooked on fentanyl.
As medical staff managed her infection, she began to panic. The onset of withdrawal began. She slumped forward and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she had to return to get high again. She thought she still had four weeks left to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the infection in her legs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie gave birth to a baby girl weighing a small weight – premature, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt sick. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she was unsuccessful. She felt hopeless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her source refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The common assumption that her bond with her newborn would make her stop using only led to deeper self-loathing and negative self-talk, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would hurt her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
After two days she decided to name her baby Izzie, after the attendant who showed compassion to her.
Hospital staff told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, results get better, fewer children enter care and future expenses reduce.
It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to collect her.
She departed the institution still in recovery, 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 hesitant about parenting. The fear lingered: that at any point, someone could arrive and take her baby away.
For the first two weeks, 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 getting by. Substances came first; trust came last.
Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to value herself, much less anyone else.
Every day, staff from the center transported her to a clinic for methadone, administered in pill form. Slowly, she was embracing sobriety.
She utilized each moment 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 adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.
On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She keeps a photo of the moment. She is clad in casual attire, a beanie with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby on her lap for the young ones to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “What about the fathers?” 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’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion 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 would become a mother.”
Approaches for managing drug-exposed newborns have been used for a long time.
The Finnegan NAS scale was developed in 1975|
