She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she resided in a small structure she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and vomited.
Stephanie finally broke down. “I have to get out of here. 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 use once more. She thought she still had a month remaining to find a way to become sober and have this baby.
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 leg infection was critical, but doctors had discovered she also had an leakage of amniotic fluid. 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 measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie had a infant weighing a small weight – premature, tiny yet healthy.
When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been administered a few hours prior to birth.
She felt sick. Not ready for motherhood. Unworthy.
Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her source declined to supply to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her affection for her child would make her stop using only led to greater shame and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt empty. “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 call her daughter the same as her nurse, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a new kind of care center where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to pick her up.
She stepped out of the hospital still in detox, scared and uncertain about what would come next.
At the facility, Stephanie still feared that child services would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any time, someone could enter and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She was unable to value herself, let alone anyone else.
Every day, staff from Maddie’s Place took her to a recovery program, administered in pill form. Slowly, she was starting to get clean.
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 sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, stopped by with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in wonder 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. None of those things mattered to them.”
She has an image of the moment. She is wearing black pants and a hoodie, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is lean. Her face is downcast so you do not see her expression. She is holding Izzie up on her leg for the young ones to see and they are gathered around, showing interest to the baby.
Jacob, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the men were occupied, called away to other tasks, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I could be a mom.”
Approaches for managing drug-exposed newborns have been available for years.
The assessment tool was created in 1975|
