Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, the expectant mother visited the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also hooked on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”
She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had four weeks left to figure out how to get clean and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
A short time later, on the 12th of November, Stephanie gave birth to a baby girl weighing 4lb 8oz – born before term, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been given a few hours prior to birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her dealer refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her love for her baby would make her recover only led to deeper self-loathing and negative self-talk, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to give her child the name the same as her nurse, after the professional who provided support to her.
Medical personnel told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.
In numerous states, where a baby is diagnosed with newborn addiction symptoms frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, fewer children enter care and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.
She left the medical center still in withdrawal, fearful and unsure about what would follow.
At Maddie’s Place, Stephanie still was concerned that CPS would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could enter and separate them.
For the initial fortnight, 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.”
Homelessness, she said, was about survival. Substances came first; trust 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.
Each day, staff from the facility drove her to a treatment center, given as medication. Over time, she was embracing sobriety.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an specialist – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a peer support specialist, stopped by with her own five kids in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in admiration 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. Such issues were irrelevant.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a beanie with a decoration on her head, seated on the ground with the entryway at her back. She is lean. Her face is downcast so you do not see her expression. She is holding Izzie up on her knee for the children to see and they are crowding near, admiring and touching to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I would become a mother.”
Tools for treating drug-exposed newborns have been used for a long time.
The Finnegan NAS scale was created in 1975|