She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she resided in a small structure she had built in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. Withdrawal was setting in. She slumped forward and vomited.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had consumed opioids before arriving at the hospital and had just enough time to get treated before she needed to go home to relapse. She thought she still had a month remaining to find a way to become sober and give birth.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie had a baby girl weighing just over four pounds – premature, little but surviving.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her supplier declined to supply to her when she became obviously with child.
“But I couldn’t,” she said. “I needed help.”
The common assumption that her love for her baby would make her recover only led to deeper self-loathing and negative self-talk, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.
The baby was taken to the special care nursery. When Stephanie at last met her, she was hooked up to monitors, so little she thought she would break her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to give her child the name after her caregiver, after the professional who provided support to her.
Hospital staff told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is identified with newborn addiction symptoms frequently, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when parents and infants remain united, results get better, 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, two staff members came to collect her.
She departed the institution still in recovery, anxious and doubtful about what would follow.
At the care center, Stephanie still feared that CPS would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could arrive and separate them.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Drugs came first; reliance came last.
Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to hurt her. She lacked the ability to love herself, not to mention anyone else.
Every day, staff from the center transported her to a clinic for methadone, provided orally. Slowly, she was embracing sobriety.
She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all common issues for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, came over with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She has an image of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, sitting on the wooden floor with the door behind her. She is thin. Her face is downcast so you cannot see her face. She is lifting the baby on her leg for the other kids to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could parent.”
Approaches for managing drug-exposed newborns have been used for a long time.
The assessment tool was developed in 1975|
