Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother visited the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and vomited.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”
She had used fentanyl before coming to the ER and had just enough time to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and have this baby.
The attending nurse disagreed. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the leg infection was serious, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.
After five days, on the 12th of November, Stephanie gave birth to 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 emotionless. Her epidural had failed, her previous intake of fentanyl had been provided a few hours prior to birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her supplier refused to sell to her when she became clearly expecting.
“But I couldn’t,” she said. “I needed help.”
The pervasive expectation that her bond with her newborn would make her recover only led to deeper self-loathing and self-harm, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to monitors, so tiny she thought she would break her. Embracing her at last, she felt empty. “I just stared 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 give her child the name the same as her nurse, after the nurse who had been so kind to her.
Nurses and doctors 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 identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like the care home is demonstrating a key fact: when parents and infants remain united, results get better, fewer children enter care and overall savings increase.
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 pick her up.
She departed the institution still in detox, anxious and doubtful about what would come next.
At the facility, Stephanie still worried that authorities would come take Izzie – 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 didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Addiction came first; reliance came last.
Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to cause pain. She was unable to value herself, much less anyone else.
Every day, staff from Maddie’s Place drove her to a recovery program, given as medication. Slowly, she was beginning recovery.
She devoted all her time 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 pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an specialist – all common issues for babies born with NAS.
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 was in the common room, where parents in active addiction can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own five kids in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in awe of the tiny infant 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 dressed in casual attire, a gray knit hat with a pompom on her head, resting on the floor 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 knee for the children to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could be a mom.”
Approaches for managing drug-exposed newborns have been used for a long time.
The evaluation method was developed in 1975|
