Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, a woman named Stephanie went to the hospital emergency room after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She slumped forward and became sick.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before coming to the ER and had only a brief window to get treated before she needed to go home to get high again. She thought she still had a month remaining to find a way to become sober and give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie controlled doses 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 frequently utilized in rehabilitation.
After five days, on a day in November 2022, Stephanie gave birth to a daughter weighing a small weight – born before term, little but surviving.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been given shortly before she gave birth.
She felt sick. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she relapsed. She felt worthless, berating herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her source declined to supply to her when she became visibly pregnant.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was connected to monitors, so small she thought she would break her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the professional who provided support to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to pick her up.
She stepped out of the hospital still in recovery, fearful and unsure about what would happen next.
At the facility, Stephanie still was concerned that CPS would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any time, someone could walk in and separate them.
For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Homelessness, she said, was about enduring. Substances came first; trust came last.
Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to let her down. She was unable to value herself, let alone anyone else.
Every day, staff from the center drove her to a recovery program, given as medication. Over time, she was beginning recovery.
She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention 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 sensory challenges and required an occupational therapist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own family in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She keeps a photo 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 thin. Her face is downcast so you do not see her expression. She is holding Izzie up on her knee for the children to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the mothers: “Where are all the dads?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could parent.”
Methods to address drug-exposed newborns have existed for decades.
The evaluation method was created in 1975|
