A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the ER after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she had to return to relapse. She thought she still had several weeks to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
After five days, on a day in November 2022, Stephanie gave birth to a daughter weighing just over four pounds – premature, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been given four hours before delivery.
She felt ill. Ill-equipped for parenting. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she was unsuccessful. She felt worthless, berating herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her dealer refused to sell to her when she became clearly expecting.
“But I couldn’t,” she said. “I needed help.”
The widespread belief that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The infant was moved to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would harm her. Holding her for the first time, she felt nothing. “I gazed upon 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 name her baby Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when mothers and babies stay together, outcomes improve, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to pick her up.
She departed the institution still in withdrawal, scared and uncertain about what would follow.
At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about survival. Drugs came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to cause pain. She lacked the ability to love herself, much less anyone else.
Daily, staff from the center drove her to a clinic for methadone, given as medication. Over time, she was starting to get clean.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. An advocate, a recovery coach, stopped by with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” 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 cap with a bobble on her head, resting on the floor with the exit nearby. She is slender. Her posture is humble so you cannot see her face. She is presenting her daughter on her leg for the other kids to see and they are crowding near, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there if they could.
“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.”
Methods to address babies with exposure have been used for a long time.
The Finnegan NAS scale was developed in 1975|
