She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Saved Them Both.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before coming to the ER and had just enough time to get treated before she had to return to relapse. She thought she still had four weeks left to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the leg infection was serious, 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 face grave danger.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
Five days later, on the 12th of November, Stephanie delivered a daughter weighing just over four pounds – premature, little but surviving.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided a few hours prior to birth.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she was unsuccessful. She felt hopeless, criticizing 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 obviously with child.
“But I couldn’t,” she said. “I required assistance.”
The pervasive expectation that her affection for her child would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would hurt her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
After two days she decided to give her child the name Izzie, after the professional who provided support to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where women and their babies are supported as a unit, not apart.
In numerous states, where a baby is identified with newborn addiction symptoms regularly, 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 showing an important truth: when families are kept intact, results get better, fewer children enter care and overall savings increase.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to collect her.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could walk in and remove her child.
For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about survival. Drugs came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to let her down. She was unable to love herself, much less anyone else.
Daily, staff from the facility drove her to a treatment center, provided orally. Slowly, she was embracing sobriety.
She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an specialist – all typical problems for babies born with NAS.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. A support specialist, a mentor, visited with her own family in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is dressed in black pants and a hoodie, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is lean. Her face is downcast so you do not see her expression. She is lifting the baby on her leg for the children to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”
Tools for treating infants affected by substances have existed for decades.
The evaluation method was established in 1975|
