Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
Pregnant and experiencing intense discomfort, the expectant mother visited the medical facility after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and became sick.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to get high again. She thought she still had four weeks left to find a way to become sober and have this baby.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in addiction recovery.
Five days later, on 12 November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, tiny yet healthy.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would break her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the nurse who had been so kind 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 identified with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like the care home is showing an important truth: when families are kept intact, recovery succeeds, custody cases decrease and overall savings increase.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to collect her.
She left the medical center still in recovery, anxious and doubtful about what would come next.
At the facility, Stephanie still worried that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could arrive and remove her child.
For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Drugs came first; reliance came last.
Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to hurt her. She was unable to value herself, not to mention anyone else.
Every day, staff from the center drove her to a recovery program, given as medication. Slowly, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. A support specialist, a mentor, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
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, seated on the ground with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is lifting the baby 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 parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I would become a mother.”
Approaches for managing babies with exposure have existed for decades.
The evaluation method was developed in 1975|
