She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother visited the ER after an infection began spreading up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a friend’s yard. She was also hooked on fentanyl.
As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and became sick.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had four weeks left to plan her recovery 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 severe, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
A short time later, on the 12th of November, Stephanie delivered a infant weighing just over four pounds – early, small but alive.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her epidural had failed, her last dose of fentanyl had been provided a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she relapsed. She felt worthless, blaming herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became visibly pregnant.
“However, I failed,” she said. “I had to seek support.”
The common assumption that her love for her baby would make her quit only led to greater shame and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was hooked up to medical equipment, so small she thought she would harm her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to name her baby the same as her nurse, after the professional who provided support to her.
Nurses and doctors told her about a care center, a new kind of care center where women and their babies are treated together, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, fewer children enter care and long-term costs decline.
It took Stephanie some time to build confidence to call, but she finally did. After confirming she would be a good fit for the program, a couple of employees came to collect her.
She stepped out of the hospital still in recovery, scared and uncertain about what would happen next.
At the care center, Stephanie still worried that authorities would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could enter and separate them.
For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to love herself, not to mention anyone else.
Daily, staff from the facility drove her to a treatment center, administered in pill form. Over time, she was embracing sobriety.
She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all typical problems for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I would become a mother.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, came over with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She holds a picture of the moment. She is wearing casual attire, a gray knit hat with a pompom on her head, sitting on the wooden floor with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the other kids to see and they are gathered around, admiring and touching to the baby.
One child, eight, asked the moms: “Why are there no men?” The parents responded that the dads were busy, 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. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I would become a mother.”
Tools for treating babies with exposure have existed for decades.
The assessment tool was created in 1975|