She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
Pregnant and experiencing intense discomfort, the expectant mother arrived at the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also hooked on fentanyl.
As doctors treated her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had a month remaining to find a way to become sober and deliver her child.
The medical professional intervened. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was critical, 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.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.
A short time later, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – premature, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been given four hours before delivery.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery multiple times while expecting, and felt terrible each time she was unsuccessful. She felt worthless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her source would not provide to her when she became visibly pregnant.
“Yet I was unable,” she said. “I had to seek support.”
The common assumption that her bond with her newborn would make her stop using only led to increased guilt and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The newborn was transferred to the NICU. When Stephanie eventually visited her, she was connected to monitors, so tiny she thought she would break her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to call her daughter Izzie, after the professional who provided support to her.
Medical personnel told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.
In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a developing system of centers like the care home is proving a simple point: when parents and infants remain united, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in recovery, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still worried that CPS would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could enter and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about enduring. Drugs came first; reliance came last.
Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to let her down. She lacked the ability to care for herself, much less anyone else.
Every day, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Over time, she was embracing sobriety.
She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all typical problems 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 sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. An advocate, a mentor, came over with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She keeps a photo of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a bobble on her head, sitting on the wooden floor with the exit nearby. She is slender. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are gathered around, showing interest to the baby.
One child, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”
Tools for treating babies with exposure have been available for years.
The Finnegan NAS scale was created in 1975|
