She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Rescued Both Lives.
Eight months pregnant and in severe pain, the expectant mother went to the ER after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a companion's property. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She bent over the bedside and became sick.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had taken the drug before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The medical professional intervened. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was serious, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie controlled doses 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 substance abuse treatment.
After five days, on 12 November 2022, Stephanie gave birth to a infant weighing a small weight – born before term, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt ill. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she failed. She felt without value, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her dealer would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her bond with her newborn would make her stop using only led to greater shame and self-harm, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the special care nursery. When Stephanie at last met her, she was hooked up to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to give her child the name after her caregiver, after the professional who provided support to her.
Hospital staff told her about a specialized facility, a new kind of care center where women and their babies are treated together, not apart.
In much of the US, where a baby is found to have infant withdrawal condition regularly, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.
It took Stephanie some time to build confidence to call, but she finally did. 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, scared and uncertain about what would happen next.
At the care center, Stephanie still worried that authorities would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could walk in and separate them.
For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to let her down. She did not know how to love herself, not to mention anyone else.
Each day, staff from the facility transported her to a treatment center, provided orally. Slowly, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” 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 clad in casual attire, a cap with a pompom on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby 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: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could parent.”
Tools for treating infants affected by substances have existed for decades.
The Finnegan NAS scale was created in 1975|