She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.
In her eighth month of pregnancy and suffering, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also addicted to fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and threw up.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before seeking medical help and had only a brief window to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and give birth.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the infection in her legs was serious, 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 be at risk of death.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.
After five days, on a day in November 2022, Stephanie had a infant weighing 4lb 8oz – premature, tiny yet healthy.
When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered four hours before delivery.
She felt sick. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery several times during pregnancy, and felt terrible each time she relapsed. She felt without value, criticizing herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her supplier would not provide to her when she became obviously with child.
“But I couldn’t,” she said. “I needed help.”
The widespread belief that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.
The newborn was transferred to the NICU. When Stephanie eventually visited her, she was attached to tubes and leads, so tiny she thought she would break her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to call her daughter the same as her nurse, after the nurse who had been so kind to her.
Hospital staff told her about a care center, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.
In much of the US, where a baby is found to have newborn addiction symptoms frequently, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when parents and infants remain united, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, two staff members came to bring her to the facility.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would follow.
At the facility, Stephanie still worried that CPS would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could enter and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Survival outdoors, she said, was about survival. Substances came first; reliance came last.
Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to cause pain. She did not know how to value herself, much less anyone else.
Every day, staff from the center took her to a treatment center, given as medication. Over time, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an professional – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, visited with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She has an image of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a pompom on her head, seated on the ground with the entryway at her back. She is thin. Her posture is humble so you cannot see her face. She is presenting her daughter on her leg for the young ones to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the parents: “Why are there no men?” The parents responded that the dads were busy, handling responsibilities, that they would be there given the chance.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could be a mom.”
Methods to address babies with exposure have existed for decades.
The evaluation method was developed in 1975|
