Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the medical facility after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and deliver her child.
The attending nurse disagreed. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.
A short time later, on a day in November 2022, Stephanie delivered a daughter weighing 4lb 8oz – premature, little but surviving.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had sought recovery multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her source declined to supply to her when she became visibly pregnant.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her stop using only led to increased guilt and self-harm, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to tubes and leads, so little she thought she would harm her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.
In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and overall savings increase.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to bring her to the facility.
She left the medical center still in recovery, scared and uncertain about what would happen next.
At the facility, Stephanie still worried that CPS would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could walk in and take her baby away.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about enduring. Addiction came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to let her down. She was unable to value herself, not to mention anyone else.
Daily, staff from the facility drove her to a treatment center, administered in pill form. Gradually, she was beginning recovery.
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 intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an specialist – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I could do this. I could be a mom.
On a day prior to the holiday, Stephanie was in the common room, where those still using can come for guided meetings with their babies. A support specialist, a recovery coach, visited with her own five kids in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, resting on the floor with the door behind her. She is thin. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her lap for the other kids to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if possible.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized 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 assessment tool was developed in 1975|
