Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had built in a companion's property. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and threw up.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to plan her recovery and deliver her child.
The nurse had other ideas. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
After five days, on a day in November 2022, Stephanie had a infant weighing 4lb 8oz – early, tiny yet healthy.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her source refused to sell to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her affection for her child would make her quit only led to deeper self-loathing and self-abuse, a cause 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 special care nursery. When Stephanie finally saw her her, she was connected to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure 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.
Medical personnel told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, outcomes improve, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to pick her up.
She departed the institution still in withdrawal, anxious and doubtful about what would happen next.
At the care center, Stephanie still worried that authorities would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and remove her child.
For the first two weeks, Stephanie remained isolated. “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 bond was fragile. The those close to her always found ways to hurt her. She lacked the ability to love herself, let alone anyone else.
Each day, staff from the center transported her to a treatment center, provided orally. Over time, she was starting to get clean.
She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I could do this. 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 peer support specialist, visited 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 kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing black pants and a hoodie, a cap with a pompom on her head, seated on the ground with the door behind her. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her lap for the young ones to see and they are crowding near, fawning and reaching out to the baby.
A young boy, eight, asked the moms: “What about the fathers?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”
Tools for treating babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
