She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother went to the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she needed to go home to use once more. She thought she still had a month remaining to plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the leg infection was severe, 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 not survive.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
Five days later, on the 12th of November, Stephanie gave birth to a baby girl weighing just over four pounds – born before term, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been given four hours before delivery.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt awful each time she relapsed. She felt without value, blaming herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her source refused to sell to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The common assumption that her love for her baby would make her stop using only led to greater shame and negative self-talk, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The newborn was transferred to the NICU. When Stephanie at last met her, she was attached to medical equipment, so tiny she thought she would break her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.
Medical personnel told her about a care center, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, results get better, fewer children enter care and future expenses reduce.
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, a couple of employees came to bring her to the facility.
She left the medical center still in detox, anxious and doubtful about what would come 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 fear lingered: that at any moment, someone could enter and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; faith came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to care for herself, let alone anyone else.
Daily, staff from the center took her to a treatment center, 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 daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. A support specialist, a mentor, visited with her own family in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a beanie with a pompom on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast 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, admiring and touching to the baby.
Jacob, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the fathers had obligations, handling responsibilities, 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 looked at each other. “I broke down,” 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 existed for decades.
The evaluation method was created in 1975|
