She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, a woman named Stephanie went to the ER after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had constructed in a acquaintance's garden. She was also hooked on fentanyl.
As doctors treated her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and threw up.
Stephanie finally broke down. “I have to get out of here. 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 had to return to relapse. She thought she still had four weeks left 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 hospital refused to discharge her: the leg infection was severe, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is frequently utilized in substance abuse treatment.
After five days, on the 12th of November, Stephanie gave birth to a daughter weighing 4lb 8oz – early, tiny yet healthy.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt awful each time she was unsuccessful. She felt worthless, criticizing herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her source would not provide to her when she became obviously with child.
“But I couldn’t,” she said. “I needed help.”
The common assumption that her affection for her child would make her quit only led to greater shame and negative self-talk, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.
The infant was moved to the NICU. When Stephanie at last met her, she was connected to medical equipment, so little she thought she would harm her. Embracing her at last, she felt empty. “I just stared at 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 call her daughter after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, recovery succeeds, foster placements fall and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to pick her up.
She left the medical center still in withdrawal, fearful and unsure about what would follow.
At Maddie’s Place, Stephanie still worried that child services would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could arrive and separate them.
For the initial fortnight, Stephanie stayed withdrawn. “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.”
Life on the streets, she said, was about enduring. Addiction came first; faith came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She lacked the ability to value herself, much less anyone else.
Every day, staff from Maddie’s Place transported her to a recovery program, provided orally. Slowly, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a recovery coach, came over with her own children 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 awe of the small baby 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 wearing black pants and a hoodie, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is lean. Her face is downcast so you cannot see her face. She is lifting the baby on her lap for the other kids to see and they are crowding near, showing interest to the baby.
One child, eight, asked the parents: “Why are there no men?” The parents responded that the dads were busy, handling responsibilities, that they would be there if they could.
“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could be a mom.”
Tools for treating drug-exposed newborns have been available for years.
The Finnegan NAS scale was developed in 1975|
