Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had a month remaining to plan her recovery and deliver her child.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the infection in her legs was critical, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.
A short time later, on the 12th of November, Stephanie gave birth to a daughter weighing 4lb 8oz – early, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been given shortly before she gave birth.
She felt sick. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery repeatedly before birth, and felt terrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to do the impossible. An obstetrician told her to “only” stop using. Even her source would not provide to her when she became clearly expecting.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her stop using only led to greater shame and negative self-talk, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected 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 continued to doubt she wanted to be her mother.
After two days she decided to call her daughter the same as her nurse, after the professional who provided support to her.
Medical personnel told her about a care center, a unique recovery environment where women and their babies are treated together, not apart.
In much of the US, where a baby is identified with newborn addiction symptoms frequently, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is showing an important truth: when parents and infants remain united, outcomes improve, fewer children enter care and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to bring her to the facility.
She left the medical center still in withdrawal, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could arrive and take her baby away.
For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about survival. Addiction came first; trust came last.
Stephanie had one close friend, 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.
Every day, staff from the facility drove her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.
She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a peer support specialist, stopped by with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She keeps a photo of the moment. She is clad in black pants and a hoodie, a gray knit hat with a pompom on her head, resting on the floor with the entryway at her back. 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 crowding near, admiring and touching to the baby.
Jacob, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if possible.
“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could parent.”
Methods to address infants affected by substances have existed for decades.
The evaluation method was established in 1975|
