Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after her infection worsened up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had constructed 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 bent over the bedside and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had four weeks left to figure out how to get clean and deliver her child.
The attending nurse disagreed. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the medical facility declined to release her: the leg infection was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, 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 treatment that reduces symptoms and is often prescribed in substance abuse treatment.
After five days, on the 12th of November, Stephanie had a infant weighing 4lb 8oz – early, small but alive.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was emotionless. 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. Undeserving.
Stephanie had sought recovery multiple times while expecting, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I needed help.”
The widespread belief that her love for her baby would make her quit only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the NICU. When Stephanie eventually visited her, she was attached to medical equipment, so little 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 remained uncertain she wanted to be her mother.
After two days she decided to call her daughter 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 numerous states, where a baby is identified with infant withdrawal condition regularly, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is demonstrating a key fact: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to collect her.
She stepped out of the hospital still in recovery, scared and uncertain about what would come next.
At the care center, Stephanie still feared that authorities would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and separate them.
For the first two weeks, Stephanie stayed withdrawn. “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 enduring. Substances came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to hurt her. She was unable to value herself, not to mention anyone else.
Each day, staff from the facility took her to a clinic for methadone, administered in pill form. Over time, 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 infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I could do this. I could parent.
On a day prior to the holiday, Stephanie was in the common room, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, came over with her own family in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She keeps a photo of the moment. She is dressed in casual attire, a cap with a decoration on her head, resting on the floor with the door behind her. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter 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 moms tried to explain that the fathers had obligations, 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. They will know they are valued.”
Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could parent.”
Methods to address infants affected by substances have existed for decades.
The assessment tool was developed in 1975|
