Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
Pregnant and experiencing intense discomfort, the expectant mother visited the ER after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had built in a acquaintance's garden. She was also hooked on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had used fentanyl before seeking medical help and had just enough time to get treated before she had to return to get high again. She thought she still had four weeks left 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 condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.
Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – premature, tiny yet healthy.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Undeserving.
Stephanie had sought recovery multiple times while expecting, and felt terrible each time she relapsed. She felt worthless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“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 greater shame and self-abuse, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to tubes and leads, so tiny she thought she would hurt her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to call her daughter Izzie, after the professional who provided support to her.
Hospital staff told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In many parts of America, where a baby is identified with newborn addiction symptoms regularly, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to bring her to the facility.
She departed the institution still in withdrawal, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could arrive and remove her child.
For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about getting by. Drugs came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She did not know how to care for herself, let alone anyone else.
Daily, staff from the center transported her to a recovery program, provided orally. Slowly, she was beginning recovery.
She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an professional – all frequent conditions for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a peer support specialist, came over with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the other kids to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could parent.”
Approaches for managing babies with exposure have been used for a long time.
The evaluation method was established in 1975|