Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother went to the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a companion's property. She was also hooked on fentanyl.
As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had four weeks left to figure out how to get clean and have this baby.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in substance abuse treatment.
After five days, on 12 November 2022, Stephanie had a infant weighing a small weight – premature, tiny yet healthy.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.
She felt sick. Unprepared to be a mother. Unworthy.
Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she failed. She felt without value, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer refused to sell to her when she became visibly pregnant.
“However, I failed,” she said. “I needed help.”
The common assumption that her bond with her newborn would make her quit only led to increased guilt and negative self-talk, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.
The baby was taken to the NICU. When Stephanie at last met her, she was hooked up to medical equipment, so tiny she thought she would break her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She continued to doubt 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.
Nurses and doctors told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is identified with infant withdrawal condition regularly, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, 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, care providers came to bring her to the facility.
She left the medical center still in recovery, anxious and doubtful about what would come next.
At the facility, Stephanie still was concerned that authorities would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any point, someone could enter and take her baby away.
For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about getting by. Substances came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to let her down. She lacked the ability to love herself, let alone anyone else.
Every day, staff from the center drove her to a recovery program, administered in pill form. Slowly, she was starting to get clean.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.
One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own five kids in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in awe 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. None of those things mattered to them.”
She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is lean. Her face is downcast so you cannot see her face. She is holding Izzie up on her lap for the children to see and they are gathered around, showing interest to the baby.
Jacob, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there given the chance.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I would become a mother.”
Methods to address drug-exposed newborns have been available for years.
The assessment tool was established in 1975|
