Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also dependent on fentanyl.
As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had taken the drug before coming to the ER and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to find a way to become sober and deliver her child.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.
After five days, on a day in November 2022, Stephanie delivered a infant weighing 4lb 8oz – early, tiny yet healthy.
When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been administered four hours before delivery.
She felt ill. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she failed. She felt worthless, criticizing herself for not being able to do the impossible. An obstetrician 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 had to seek support.”
The pervasive expectation that her affection for her child would make her stop using only led to deeper self-loathing and self-harm, a cause 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 NICU. When Stephanie eventually visited her, she was connected to monitors, so tiny she thought she would hurt her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the attendant who showed compassion to her.
Nurses and doctors told her about a specialized facility, a innovative treatment home where women and their babies are treated together, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, fewer children enter care and overall savings increase.
It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, two staff members came to collect her.
She stepped out of the hospital still in detox, anxious and doubtful about what would happen next.
At the care center, Stephanie still worried that CPS would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any time, someone could walk in and remove her child.
For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about getting by. Addiction came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to love herself, not to mention anyone else.
Every day, staff from the center took her to a treatment center, given as medication. Gradually, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had sensory challenges and required an specialist – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I was capable. 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. An advocate, a recovery coach, came over with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She has an image of the moment. She is clad in casual attire, a gray knit hat with a pompom on her head, sitting on the wooden floor with the door behind her. She is slender. Her posture is humble so you do not see her expression. She is lifting the baby on her leg for the children to see and they are gathered around, admiring and touching to the baby.
A young boy, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I would become a mother.”
Methods to address infants affected by substances have been used for a long time.
The Finnegan NAS scale was developed in 1975|
