She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had taken the drug before coming to the ER and had only a brief window to get treated before she had to return to get high again. She thought she still had four weeks left to figure out how to get clean and deliver her child.
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 condition in her limbs was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.
Five days later, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – early, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her pain relief did not work, her last dose of fentanyl had been provided four hours before delivery.
She felt sick. Unprepared to be a mother. Unworthy.
Stephanie had sought recovery repeatedly before birth, and felt awful each time she failed. She felt worthless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became obviously with child.
“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 negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could overcome a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to medical equipment, so small she thought she would harm her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to give her child the name the same as her nurse, after the professional who provided support to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, custody cases decrease and long-term costs decline.
It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to pick her up.
She stepped out of the hospital still in recovery, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still feared that CPS would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could walk in and remove her child.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Substances came first; trust came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to value herself, let alone anyone else.
Daily, staff from Maddie’s Place transported her to a recovery program, administered in pill form. Over time, she was embracing sobriety.
She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies exposed to substances.
Seeing that even a young person understands the need for care, then I could do this. I would become a mother.
On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. 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 bobble on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast so you cannot see her face. She is presenting her daughter on her knee for the other kids to see and they are gathered around, showing interest to the baby.
One child, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could parent.”
Approaches for managing babies with exposure have existed for decades.
The Finnegan NAS scale was developed in 1975|
