Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother arrived at the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”
She had taken the drug before seeking medical help and had only a brief window to get treated before she needed to go home to use once more. She thought she still had several weeks to figure out how to get clean and deliver her child.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.
After five days, on a day in November 2022, Stephanie had a daughter weighing a small weight – born before term, tiny yet healthy.
When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been provided four hours before delivery.
She felt unwell. Ill-equipped for parenting. Unworthy.
Stephanie had sought recovery multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her supplier declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her stop using only led to greater shame and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the NICU. When Stephanie at last met her, she was connected to monitors, so little she thought she would harm her. Embracing her at last, 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.
After two days she decided to name her baby after her caregiver, after the professional who provided support to her.
Medical personnel told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to pick her up.
She left the medical center still in withdrawal, scared and uncertain about what would come next.
At Maddie’s Place, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could walk in and separate them.
For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about survival. Addiction came first; reliance came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to hurt her. She lacked the ability to care for herself, not to mention anyone else.
Every day, staff from Maddie’s Place took her to a recovery program, administered in pill form. Gradually, she was beginning recovery.
She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all common issues for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. A support specialist, a recovery coach, visited with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her head is tilted forward so you cannot see her face. She is lifting the baby on her leg for the children to see and they are gathered around, showing interest to the baby.
Jacob, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there given the chance.
“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could parent.”
Approaches for managing babies with exposure have been available for years.
The evaluation method was created in 1975|
