Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, 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 stayed in a makeshift shelter she had built in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she needed to go home to relapse. She thought she still had several weeks to plan her recovery and have this baby.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.
A short time later, on 12 November 2022, Stephanie delivered a baby girl weighing just over four pounds – born before term, little but surviving.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been given a few hours prior to birth.
She felt sick. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt awful each time she failed. She felt worthless, blaming herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her supplier declined to supply to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The pervasive expectation that her bond with her newborn would make her recover only led to deeper self-loathing and self-abuse, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would harm her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to give her child the name after her caregiver, after the professional who provided support to her.
Hospital staff told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, two staff members came to collect her.
She departed the institution still in withdrawal, scared and uncertain about what would happen next.
At the facility, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any point, 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 lacked confidence at that point.”
Homelessness, she said, was about survival. Drugs came first; trust came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to hurt her. She did not know how to value herself, much less anyone else.
Each day, staff from the center transported her to a treatment center, given as medication. Slowly, she was beginning recovery.
She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an professional – all typical problems for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a peer support specialist, came over with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing casual attire, a cap with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her face is downcast so you cannot see her face. She is presenting her daughter on her knee for the young ones to see and they are standing close, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the men were occupied, called away to other tasks, 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 her companion looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I would become a mother.”
Methods to address babies with exposure have been available for years.
The assessment tool was developed in 1975|
