She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the ER after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”
She had consumed opioids before seeking medical help and had just enough time to get treated before she had to return to relapse. She thought she still had a month remaining to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the infection in her legs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in rehabilitation.
After five days, on the 12th of November, Stephanie delivered a daughter weighing a small weight – early, small but alive.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her epidural had failed, her final administration of fentanyl had been given shortly before she gave birth.
She felt ill. Not ready for motherhood. Unworthy.
Stephanie had sought recovery repeatedly before birth, and felt terrible each time she failed. She felt hopeless, berating herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her quit only led to increased guilt and negative self-talk, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.
The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was attached to tubes and leads, so small she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name the same as her nurse, after the nurse who had been so kind to her.
Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is diagnosed with infant withdrawal condition regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, results get better, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to pick her up.
She left the medical center still in recovery, fearful and unsure about what would follow.
At the facility, Stephanie still feared that authorities would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could walk in and separate them.
For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about survival. Addiction came first; trust came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She was unable to love herself, let alone anyone else.
Daily, staff from Maddie’s Place took her to a treatment center, administered in pill form. Slowly, she was beginning recovery.
She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an professional – all typical problems for babies affected by withdrawal.
When a child recognizes these infants need affection, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own children in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She holds a picture of the moment. She is clad in casual attire, a gray knit hat with a bobble on her head, resting on the floor with the door behind her. She is thin. Her face is downcast so you cannot see her face. She is lifting the baby on her knee for the other kids to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “Why are there no men?” The parents responded that the men were occupied, handling responsibilities, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could be a mom.”
Approaches for managing drug-exposed newborns have been used for a long time.
The assessment tool was developed in 1975|