She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother arrived at the medical facility after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, 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 began to panic. The onset of withdrawal began. She slumped forward and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”
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 plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.
A short time later, on 12 November 2022, Stephanie delivered a daughter weighing a small weight – premature, little but surviving.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her epidural had failed, her last dose of fentanyl had been given a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she failed. She felt hopeless, berating herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her source would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I needed help.”
The common assumption that her bond with her newborn would make her quit only led to increased guilt and self-abuse, a impetus for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.
The baby was taken to the special care nursery. When Stephanie eventually visited her, she was hooked up to tubes and leads, so little she thought she would hurt 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 call her daughter the same as her nurse, after the nurse who had been so kind to her.
Nurses and doctors told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is identified with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, results get better, foster placements fall and overall savings increase.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to pick her up.
She stepped out of the hospital still in withdrawal, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still was concerned that CPS would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could enter and separate them.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about survival. Substances came first; trust 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 was unable to value herself, not to mention anyone else.
Daily, staff from the facility drove her to a treatment center, administered in pill form. Over time, she was embracing sobriety.
She utilized each moment outside treatment 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 pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges 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 was capable. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a peer support specialist, came over with her own children in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She keeps a photo of the moment. She is wearing casual attire, a gray knit hat with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her posture is humble so you do not see her expression. She is presenting her daughter on her leg for the children to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”
Approaches for managing babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
