A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Saved Them Both.
Pregnant and experiencing intense discomfort, a woman named Stephanie went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a acquaintance's garden. She was also dependent on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and vomited.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and give birth.
The medical professional intervened. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the leg infection was critical, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie gave birth to a baby girl weighing a small weight – premature, tiny yet healthy.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt without value, criticizing herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The common assumption that her love for her baby would make her stop using only led to increased guilt and self-abuse, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
After two days she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.
Hospital staff 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 diagnosed with infant withdrawal condition regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when families are kept intact, results get better, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to collect her.
She departed the institution still in recovery, fearful and unsure about what would follow.
At Maddie’s Place, Stephanie still was concerned that child services would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any point, someone could enter and separate them.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about getting by. Substances came first; trust came last.
Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to let her down. She was unable to value herself, much less anyone else.
Each day, staff from the center took her to a clinic for methadone, given as medication. Gradually, she was beginning recovery.
She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues for babies affected by withdrawal.
When a child recognizes these infants need affection, then I could do this. I could parent.
One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. A support specialist, a peer support specialist, stopped by with her own family in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her face is downcast so you do not see her expression. She is presenting her daughter on her leg for the young ones to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the moms: “Why are there no men?” The parents responded that the dads were busy, called away to other tasks, that they would be there if they could.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I would become a mother.”
Tools for treating babies with exposure have been used for a long time.
The Finnegan NAS scale was developed in 1975|
