Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother went to the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had assembled in a companion's property. She was also addicted to fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to find a way to become sober and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – born before term, tiny yet healthy.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.
She felt sick. Not ready for motherhood. Unworthy.
Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt worthless, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her recover only led to deeper self-loathing and negative self-talk, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to medical equipment, so tiny she thought she would harm her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the professional who provided support to her.
Hospital staff told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, foster placements fall and future expenses reduce.
It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to collect her.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would follow.
At the facility, Stephanie still worried that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could walk in and remove her child.
For the first two weeks, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about getting by. Substances came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to let her down. She lacked the ability to value herself, not to mention anyone else.
Daily, staff from the center transported her to a treatment center, given as medication. Gradually, she was beginning recovery.
She spent every minute beyond therapy 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 heightened sensory issues and required an occupational therapist – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, came over 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 had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She holds a picture of the moment. She is clad in casual attire, a cap with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her posture is humble so you cannot see her face. She is presenting her daughter on her lap for the children to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if they could.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could parent.”
Approaches for managing drug-exposed newborns have been available for years.
The Finnegan NAS scale was created in 1975|
