Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.
In her eighth month of pregnancy and suffering, the expectant mother visited the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and threw up.
Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”
She had taken the drug before arriving at the hospital and had just enough time to get treated before she had to return to get high again. She thought she still had a month remaining to figure out how to get clean and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.
After five days, on the 12th of November, Stephanie delivered a daughter weighing a small weight – premature, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her pain relief did not work, her last dose of fentanyl had been provided a few hours prior to birth.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she failed. She felt hopeless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her dealer refused to sell to her when she became visibly pregnant.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her recover only led to deeper self-loathing and self-harm, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The baby was taken to the NICU. When Stephanie finally saw her her, she was hooked up to medical equipment, so small she thought she would hurt her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to name her baby the same as her nurse, after the nurse who had been so kind to her.
Medical personnel told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are supported as a unit, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is demonstrating a key fact: 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 eventually made the call. After verifying her eligibility for the program, care providers came to bring her to the facility.
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 take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could enter and take her baby away.
For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about getting by. Substances came first; reliance came last.
Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She was unable to care for herself, let alone anyone else.
Every day, staff from the facility drove her to a treatment center, administered in pill form. Slowly, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had sensory challenges and required an professional – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, 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 guided meetings with their babies. An advocate, a peer support specialist, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her posture is humble so you miss her features. She is holding Izzie up on her lap for the children to see and they are gathered around, showing interest to the baby.
A young boy, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there given the chance.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I would become a mother.”
Approaches for managing babies with exposure have been used for a long time.
The assessment tool was established in 1975|
