Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother went to the ER after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she lived in a shed she had built in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had several weeks to find a way to become sober and have this baby.
The medical professional intervened. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
Five days later, on a day in November 2022, Stephanie had a baby girl weighing just over four pounds – early, tiny yet healthy.
When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been given shortly before she gave birth.
She felt sick. Not ready for motherhood. Undeserving.
Stephanie had sought recovery several times during pregnancy, and felt awful each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her supplier declined to supply to her when she became clearly expecting.
“But I couldn’t,” she said. “I had to seek support.”
The widespread belief that her love for her baby would make her stop using only led to deeper self-loathing and self-abuse, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was hooked up to monitors, so little she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt 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 a care center, a new kind of care center where parents and infants affected by substance use 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 given drugs while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to pick her up.
She left the medical center still in detox, fearful and unsure about what would come next.
At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could walk in and take her baby away.
For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about survival. Substances came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She did not know how to love herself, not to mention anyone else.
Daily, staff from the center drove 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 obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an specialist – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own children in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her face is downcast so you do not see her expression. She is presenting her daughter on her leg for the children to see and they are crowding near, fawning and reaching out to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could be a mom.”
Approaches for managing infants affected by substances have been available for years.
The evaluation method was developed in 1975|
