She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
In her eighth month of pregnancy and suffering, a woman named Stephanie went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and threw up.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she needed to go home to get high again. 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 allowed to leave.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
A short time later, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – premature, tiny yet healthy.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been provided four hours before delivery.
She felt ill. Unprepared to be a mother. Unworthy.
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 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.
“But I couldn’t,” she said. “I had to seek support.”
The common assumption that her love for her baby would make her stop using only led to greater shame and negative self-talk, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The baby was taken to the NICU. When Stephanie at last met her, she was attached to medical equipment, so tiny she thought she would harm her. Cradling her initially, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Two days later she decided to name her baby after her caregiver, after the professional who provided support to her.
Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.
In many parts of America, where a baby is identified with newborn addiction symptoms frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, recovery succeeds, fewer children enter care 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 bring her to the facility.
She stepped out of the hospital still in detox, scared and uncertain about what would come next.
At the care center, Stephanie still worried that CPS would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could enter and take her baby away.
For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” 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; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to value herself, not to mention anyone else.
Every day, staff from Maddie’s Place took her to a recovery program, provided orally. Slowly, she was embracing sobriety.
She spent every minute 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 sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all frequent conditions for babies born with NAS.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a recovery coach, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She keeps a photo of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a pompom on her head, sitting on the wooden floor with the exit nearby. She is slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her lap for the other kids to see and they are standing close, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could parent.”
Tools for treating drug-exposed newborns have been available for years.
The assessment tool was established in 1975|
