She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, the expectant mother arrived at the hospital emergency room 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 assembled in a companion's property. She was also addicted to fentanyl.
As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”
She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to plan her recovery and give birth.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but medical staff detected 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.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is frequently utilized in rehabilitation.
A short time later, on the 12th of November, Stephanie delivered a infant weighing just over four pounds – premature, tiny yet healthy.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given shortly before she gave birth.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had sought recovery repeatedly before birth, and felt awful each time she relapsed. She felt without value, criticizing herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her source would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I needed help.”
The pervasive expectation that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to tubes and leads, so tiny she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” 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 nurse who had been so kind to her.
Hospital staff told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she ultimately reached out. 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, fearful and unsure about what would happen next.
At the facility, Stephanie still worried that child services would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any moment, someone could enter and remove her child.
For the beginning period, 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.”
Survival outdoors, she said, was about getting by. Drugs came first; faith came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She did not know how to love herself, let alone anyone else.
Every day, staff from the facility took her to a treatment center, given as medication. Slowly, she was embracing sobriety.
She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all typical problems for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.
One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own children in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She keeps a photo of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the children to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The parents responded that the dads were busy, handling responsibilities, 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 Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could be a mom.”
Methods to address drug-exposed newborns have existed for decades.
The assessment tool was developed in 1975|
