Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had constructed in a companion's property. She was also hooked on fentanyl.
As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had several weeks to plan her recovery and deliver her child.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the leg infection was critical, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.
After five days, on a day in November 2022, Stephanie had a infant weighing 4lb 8oz – premature, small but alive.
When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her supplier refused to sell to her when she became obviously with child.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her stop using only led to deeper self-loathing and negative self-talk, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.
The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was attached to monitors, so little she thought she would break her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.
Hospital staff told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is found to have newborn addiction symptoms regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, results get better, custody cases decrease and future expenses reduce.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to collect her.
She departed the institution still in detox, scared and uncertain about what would follow.
At Maddie’s Place, Stephanie still worried that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about survival. Addiction came first; faith came last.
Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to hurt her. She lacked the ability to care for herself, let alone anyone else.
Daily, staff from the center drove her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.
She spent every minute 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 intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an professional – all common issues for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a peer support specialist, stopped by with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. 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 decoration on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.
Jacob, eight, asked the moms: “What about the fathers?” The moms tried to explain that the dads were busy, called away to other tasks, 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 the specialist exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I would become a mother.”
Tools for treating infants affected by substances have existed for decades.
The Finnegan NAS scale was created in 1975|
