Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie went to the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also hooked on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but physicians found 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.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
After five days, on 12 November 2022, Stephanie had a baby girl weighing a small weight – premature, little but surviving.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been given four hours before delivery.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her source declined to supply to her when she became visibly pregnant.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her recover only led to deeper self-loathing and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the special care nursery. When Stephanie eventually visited her, she was hooked up to medical equipment, so small she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to give her child the name Izzie, after the attendant who showed compassion 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 neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, fewer children enter care and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to pick her up.
She left the medical center still in recovery, fearful and unsure about what would happen next.
At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any time, someone could walk in and separate them.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about enduring. Addiction came first; faith came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She did not know how to care for herself, let alone anyone else.
Daily, staff from the facility transported her to a recovery program, provided orally. Slowly, she was starting to get clean.
She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had increased sensitivity and required an professional – all frequent conditions for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.
One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a mentor, stopped by with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground 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 overlooked my addiction. Such issues were irrelevant.”
She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a bobble on her head, sitting on the wooden floor with the exit nearby. She is thin. Her head is tilted forward so you do not see her expression. She is presenting her daughter on her knee for the young ones to see and they are crowding near, showing interest to the baby.
One child, eight, asked the moms: “Why are there no men?” The moms tried to explain that the men were occupied, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I would become a mother.”
Approaches for managing babies with exposure have been used for a long time.
The Finnegan NAS scale was developed in 1975|
