Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother visited the medical facility after an infection began spreading up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had constructed in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She slumped forward and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had used fentanyl before coming to the ER and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to find a way to become sober and have this baby.
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 leg infection was critical, but physicians found 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.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.
A short time later, on 12 November 2022, Stephanie delivered a baby girl weighing a small weight – born before term, tiny yet healthy.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given shortly before she gave birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she relapsed. She felt without value, blaming herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her dealer would not provide to her when she became clearly expecting.
“However, I failed,” she said. “I required assistance.”
The common assumption that her affection for her child 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 simply will 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 break her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to call her daughter the same as her nurse, after the professional who provided support to her.
Nurses and doctors told her about a specialized facility, a innovative treatment home where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, outcomes improve, foster placements fall and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She left the medical center still in withdrawal, fearful and unsure about what would come next.
At Maddie’s Place, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive 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 was suspicious at that point.”
Life on the streets, she said, was about enduring. Drugs came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She was unable to value herself, let alone anyone else.
Every day, staff from Maddie’s Place took her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.
She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an professional – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She holds a picture of the moment. She is clad in casual attire, a cap with a pompom on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the other kids to see and they are gathered around, showing interest to the baby.
One child, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there if possible.
“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 the specialist made eye contact. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I could parent.”
Approaches for managing infants affected by substances have been available for years.
The evaluation method was established in 1975|
