Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie went to the ER after her infection worsened up her legs. Without a job or home, estranged from her family, she lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and give birth.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the doctors would not let her go: the leg infection was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
Five days later, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – born before term, small but alive.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her last dose of fentanyl had been given shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she relapsed. She felt worthless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her dealer declined to supply 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 quit only led to increased guilt and self-harm, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to tubes and leads, so tiny she thought she would harm her. Cradling her initially, she felt empty. “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.
Two days later she decided to give her child the name Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about a specialized facility, a unique recovery environment where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, recovery succeeds, custody cases decrease and future expenses reduce.
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, a couple of employees came to pick her up.
She stepped out of the hospital still in recovery, scared and uncertain about what would come next.
At Maddie’s Place, Stephanie still feared that CPS would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could enter and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about getting by. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She did not know how to value herself, not to mention anyone else.
Each day, staff from the center took her to a recovery program, given as medication. Slowly, she was starting to get clean.
She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. 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 was capable. I would become a mother.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a cap with a bobble on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her lap for the children to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could be a mom.”
Tools for treating infants affected by substances have been available for years.
The evaluation method was created in 1975|
