Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie went to the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had constructed in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to figure out how to get clean and have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was critical, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
A short time later, on a day in November 2022, Stephanie had a daughter weighing 4lb 8oz – early, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was detached. Her epidural had failed, her previous intake of fentanyl had been given four hours before delivery.
She felt unwell. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she failed. She felt worthless, blaming herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her dealer would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her bond with her newborn would make her recover only led to increased guilt and negative self-talk, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The infant was moved to the special care nursery. When Stephanie at last met her, she was attached to medical equipment, so small she thought she would harm her. Holding her for the first time, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.
Medical personnel told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like the care home is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, care providers came to pick her up.
She stepped out of the hospital still in detox, anxious and doubtful about what would happen next.
At the facility, Stephanie still worried that authorities would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any time, someone could enter and take her baby away.
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.”
Life on the streets, she said, was about enduring. Addiction came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to cause pain. She lacked the ability to care for herself, let alone anyone else.
Daily, staff from the facility transported her to a recovery program, provided orally. Slowly, she was embracing sobriety.
She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an professional – all frequent conditions for babies affected by withdrawal.
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 was in the common room, where those still using can come for monitored interactions with their babies. A support specialist, a mentor, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She has an image of the moment. She is wearing black pants and a hoodie, a beanie with a decoration on her head, resting on the floor with the exit nearby. She is slender. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The parents responded that the dads were busy, handling responsibilities, 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 became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I would become a mother.”
Tools for treating infants affected by substances have been available for years.
The Finnegan NAS scale was established in 1975|
