She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Rescued Both Lives.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at the medical facility after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had assembled in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
Five days later, on a day in November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – born before term, small but alive.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her epidural had failed, her final administration of fentanyl had been administered a few hours prior to birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt without value, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her source refused to sell to her when she became clearly expecting.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her affection for her child would make her quit only led to deeper self-loathing and self-harm, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to medical equipment, so little she thought she would break her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.
Medical personnel told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In numerous states, where a baby is found to have newborn addiction symptoms regularly, infants are still whisked to NICUs and treated with pharmaceuticals 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, outcomes improve, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to collect her.
She left the medical center still in detox, fearful and unsure about what would happen next.
At the facility, Stephanie still worried that authorities would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and remove her child.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Substances came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to cause pain. She did not know how to love herself, not to mention anyone else.
Every day, staff from the center drove her to a treatment center, given as medication. Over time, she was beginning recovery.
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 severe digestive problems. She needed dietary support. She also had sensory challenges and required an professional – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I could do this. I would become a mother.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where those still using can come for guided meetings with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She has an image of the moment. She is dressed in casual attire, a beanie with a bobble on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you miss her features. She is presenting her daughter on her lap for the young ones to see and they are gathered around, showing interest to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. 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 infants need affection, then I was able. I could be a mom.”
Approaches for managing drug-exposed newborns have been available for years.
The assessment tool was created in 1975|
