Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.
In her eighth month of pregnancy and suffering, the expectant mother went to the ER after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and became sick.
Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”
She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had a month remaining to plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an ruptured membrane. 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 at regular intervals, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
After five days, on a day in November 2022, Stephanie had a infant weighing a small weight – premature, small but alive.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been given shortly before she gave birth.
She felt ill. Ill-equipped for parenting. Unworthy.
Stephanie had sought recovery multiple times while expecting, and felt horrible each time she failed. She felt worthless, blaming herself for not being able to achieve the unattainable. An doctor 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 needed help.”
The pervasive expectation that her bond with her newborn would make her stop using only led to increased guilt and negative self-talk, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to tubes and leads, so tiny she thought she would break her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a new kind of care center where women and their babies are supported as a unit, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like the care home is showing an important truth: when mothers and babies stay together, results get better, custody cases decrease and future expenses reduce.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to bring her to the facility.
She departed the institution still in recovery, scared and uncertain about what would come next.
At the facility, Stephanie still worried that authorities would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could enter and take her baby away.
For the initial fortnight, Stephanie kept to herself. “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.”
Life on the streets, she said, was about survival. Substances came first; trust came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She lacked the ability to care for herself, let alone anyone else.
Each day, staff from the center drove her to a clinic for methadone, provided orally. Over time, she was starting to get clean.
She spent every minute when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an specialist – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could parent.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. A support specialist, a mentor, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed 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 has an image of the moment. She is clad in casual attire, a cap with a pompom on her head, resting on the floor with the entryway at her back. She is thin. Her head is tilted forward so you do not see her expression. She is lifting the baby on her knee for the other kids to see and they are gathered around, showing interest to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I would become a mother.”
Tools for treating drug-exposed newborns have been available for years.
The evaluation method was established in 1975|