A Pregnant Woman's Battle with Fentanyl Addiction: Choosing Motherhood Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother went to the medical facility after her infection worsened up her legs. Jobless and without shelter, 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 medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and vomited.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and deliver her child.
The nurse had other ideas. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was serious, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie delivered a daughter weighing just over four pounds – early, tiny yet healthy.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been provided shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she was unsuccessful. She felt hopeless, berating herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her recover only led to increased guilt and negative self-talk, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.
The infant was moved to the NICU. When Stephanie at last met her, she was attached to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the attendant who showed compassion to her.
Nurses and doctors told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is proving a simple point: when families are kept intact, results get better, foster placements fall and future expenses reduce.
It took Stephanie some time to build confidence to call, but she eventually made the call. 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 come next.
At the facility, Stephanie still feared that child services would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could walk in and separate them.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to love herself, not to mention anyone else.
Every day, staff from Maddie’s Place took her to a treatment center, provided orally. Gradually, 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 infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had sensory challenges and required an specialist – all common issues for babies born with NAS.
When a child recognizes these infants need affection, then I could do this. I would become a mother.
On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, stopped by with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a bobble on her head, resting on the floor with the door behind her. She is slender. Her face is downcast so you cannot see her face. She is presenting her daughter on her leg for the other kids to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the moms: “Why are there no men?” The parents responded that the dads were busy, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I could be a mom.”
Approaches for managing drug-exposed newborns have existed for decades.
The Finnegan NAS scale was established in 1975|
