She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Rescued Both Lives.
Eight months pregnant and in severe pain, the expectant mother visited the hospital emergency room after an infection began spreading up her legs. Without a job or home, estranged from her family, she lived in a shed she had built in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”
She had used fentanyl before seeking medical help and had just enough time to get treated before she needed to go home to use once more. She thought she still had several weeks to figure out how to get clean and have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, 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.
A short time later, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – premature, tiny yet healthy.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been given shortly before she gave birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had sought recovery repeatedly before birth, and felt awful each time she was unsuccessful. She felt worthless, berating herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her supplier refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her affection for her child would make her quit only led to increased guilt and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was hooked up to medical equipment, so little she thought she would hurt her. Embracing her at last, she felt nothing. “I looked at 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.
Medical personnel told her about a care center, a innovative treatment home 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 whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is proving a simple point: when parents and infants remain united, results get better, fewer children enter care and long-term costs decline.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in detox, anxious and doubtful about what would happen next.
At Maddie’s Place, Stephanie still worried that child services would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and take her baby away.
For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about survival. Addiction came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She did not know how to care for herself, not to mention anyone else.
Daily, staff from the facility took her to a recovery program, given as medication. Over time, she was beginning recovery.
She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an specialist – all typical problems for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, stopped by with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in admiration 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 dressed in dark trousers and a sweatshirt, a cap with a decoration on her head, seated on the ground with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I could be a mom.”
Tools for treating infants affected by substances have existed for decades.
The Finnegan NAS scale was established in 1975|
