Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie visited the ER after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had built in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and threw up.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had four weeks left to plan her recovery and deliver her child.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
She encouraged 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 drug that alleviates cravings and is often prescribed in rehabilitation.
A short time later, on a day in November 2022, Stephanie had a daughter weighing a small weight – born before term, small but alive.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been administered a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Undeserving.
Stephanie had sought recovery multiple times while expecting, and felt terrible each time she failed. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her dealer would not provide to her when she became visibly pregnant.
“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 cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was attached to monitors, so little she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the attendant who showed compassion to her.
Medical personnel told her about a specialized facility, a unique recovery environment where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when parents and infants remain united, recovery succeeds, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.
At the facility, Stephanie still feared that child services would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could enter and remove her child.
For the first two weeks, Stephanie remained isolated. “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. Drugs came first; reliance 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 did not know how to care for herself, let alone anyone else.
Every day, staff from the center transported her to a treatment center, provided orally. Over time, she was starting to get clean.
She spent every minute outside treatment 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 severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.
On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a mentor, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there if they could.
“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 became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could parent.”
Approaches for managing drug-exposed newborns have been used for a long time.
The evaluation method was developed in 1975|
