Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she resided in a small structure she had constructed in a companion's property. She was also addicted to fentanyl.
As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave 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 am leaving,” Stephanie said.
But the doctors would not let her go: the infection in her legs was serious, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
After five days, on the 12th of November, Stephanie had a infant weighing a small weight – premature, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered four hours before delivery.
She felt sick. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she failed. She felt without value, criticizing herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I needed help.”
The common assumption that her love for her baby would make her stop using only led to increased guilt and self-abuse, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to medical equipment, so little she thought she would break her. Cradling her initially, 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.
Two days later she decided to call her daughter the same as her nurse, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a new kind of care center where women and their babies are treated together, not apart.
In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a developing system of centers like this facility is proving a simple point: when mothers and babies stay together, recovery succeeds, fewer children enter care and overall savings increase.
It took Stephanie some time to build confidence to call, but she finally did. After confirming she would be a good fit for the program, care providers came to collect her.
She departed the institution still in withdrawal, scared and uncertain about what would happen next.
At the care center, Stephanie still worried that authorities would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could walk in 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 getting by. Drugs came first; trust came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to cause pain. She was unable to care for herself, let alone anyone else.
Daily, staff from Maddie’s Place took her to a clinic for methadone, given as medication. Over time, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an specialist – 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 would become a mother.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She has an image of the moment. She is clad in black pants and a hoodie, a gray knit hat with a bobble on her head, sitting on the wooden floor with the exit nearby. She is thin. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her knee for the children to see and they are standing close, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could parent.”
Approaches for managing babies with exposure have existed for decades.
The assessment tool was developed in 1975|
