Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
In her eighth month of pregnancy and suffering, a woman named Stephanie went to the ER after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had built in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had consumed opioids 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 several weeks to plan her recovery and give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the leg infection was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
After five days, on the 12th of November, Stephanie delivered a baby girl weighing just over four pounds – born before term, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been administered shortly before she gave birth.
She felt ill. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt worthless, criticizing 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 bond with her newborn would make her recover only led to greater shame and self-harm, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to monitors, so tiny she thought she would hurt her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter Izzie, after the nurse who had been so kind to her.
Hospital staff told her about a care center, a new kind of care center where women and their babies are treated together, not apart.
In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is proving a simple point: when families are kept intact, results get better, custody cases decrease and long-term costs decline.
It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to pick her up.
She left the medical center still in withdrawal, anxious and doubtful about what would happen next.
At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could walk in and remove her child.
For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She lacked the ability to love herself, not to mention anyone else.
Every day, staff from the facility took her to a treatment center, administered in pill form. Over time, she was beginning recovery.
She utilized each moment beyond therapy 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 pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own family 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 tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She has an image of the moment. She is wearing casual attire, a cap with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her posture is humble so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the parents: “Where are all the dads?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I will excel as a father. 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 infants need affection, then I found the courage. I would become a mother.”
Methods to address babies with exposure have been used for a long time.
The assessment tool was developed in 1975|
