Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie arrived at the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had built in a friend’s yard. She was also addicted to fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was critical, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.
After five days, on a day in November 2022, Stephanie had a infant weighing a small weight – premature, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.
She felt ill. Ill-equipped for parenting. Unworthy.
Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her supplier refused to sell to her when she became clearly expecting.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her love for her baby would make her quit only led to increased guilt and negative self-talk, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was hooked up to medical equipment, so small she thought she would break her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the professional who provided support to her.
Nurses and doctors told her about a specialized facility, a innovative treatment home 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 newborn addiction symptoms frequently, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like this facility is proving a simple point: when families are kept intact, results get better, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in detox, anxious and doubtful about what would happen next.
At the care center, Stephanie still was concerned that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could enter and remove her child.
For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about getting by. Substances came first; trust came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She lacked the ability to love herself, much less anyone else.
Daily, staff from Maddie’s Place transported her to a clinic for methadone, administered in pill form. Slowly, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. A support specialist, a mentor, stopped by with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is clad in black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is slender. Her posture is humble so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I could parent.”
Tools for treating drug-exposed newborns have been available for years.
The evaluation method was created in 1975|
