Fentanyl Addiction During Pregnancy: How Keeping Her Baby Rescued Both Lives.
In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also dependent on fentanyl.
As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and became sick.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”
She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and have this baby.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was critical, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie delivered a infant weighing just over four pounds – born before term, tiny yet healthy.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt worthless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source declined to supply to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The common assumption that her love for her baby would make her recover only led to deeper self-loathing and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the NICU. When Stephanie eventually visited her, she was hooked up to monitors, so small she thought she would hurt her. Holding her for the first time, she felt nothing. “I looked 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 call her daughter after her caregiver, after the professional who provided support to her.
Hospital staff told her about a care center, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when parents and infants remain united, outcomes improve, foster placements fall and overall savings increase.
It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, two staff members came to bring her to the facility.
She departed the institution still in detox, fearful and unsure about what would happen next.
At the facility, Stephanie still was concerned that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could enter and remove her child.
For the first two weeks, Stephanie kept to herself. “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.”
Homelessness, she said, was about getting by. Addiction came first; trust came last.
Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to hurt her. She did not know how to love herself, not to mention anyone else.
Each day, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Slowly, she was starting to get clean.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an specialist – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing black pants and a hoodie, a cap with a decoration on her head, seated on the ground with the exit nearby. She is thin. Her posture is humble so you miss her features. She is presenting her daughter on her leg for the young ones to see and they are standing close, admiring and touching to the baby.
Jacob, eight, asked the moms: “Why are there no men?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I found the courage. I would become a mother.”
Methods to address babies with exposure have existed for decades.
The Finnegan NAS scale was developed in 1975|
