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. Without a job or home, separated from loved ones, she lived in a shed she had assembled in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.
After five days, on the 12th of November, Stephanie gave birth to a daughter weighing a small weight – premature, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.
She felt ill. Unprepared to be a mother. Unworthy.
Stephanie had sought recovery several times during pregnancy, and felt awful each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her source declined to supply to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her quit only led to greater shame and self-abuse, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The newborn was transferred to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would break her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter 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 treated together, not apart.
In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, outcomes improve, foster placements fall and overall savings increase.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to bring her to the facility.
She left the medical center still in detox, anxious and doubtful about what would come next.
At the care center, Stephanie still feared that child services would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could arrive and separate them.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about getting by. Addiction 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 love herself, much less anyone else.
Every day, staff from Maddie’s Place took her to a treatment center, given as medication. Slowly, she was embracing sobriety.
She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.
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. A support specialist, a recovery coach, came over with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a gray knit hat with a pompom on her head, resting on the floor with the entryway at her back. She is thin. Her face is downcast so you do not see her expression. She is lifting the baby on her lap for the other kids to see and they are standing close, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there given the chance.
“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could be a mom.”
Tools for treating drug-exposed newborns have existed for decades.
The Finnegan NAS scale was developed in 1975|
