Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother arrived at 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. Withdrawal was setting in. She leaned over the bed and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to plan her recovery and have this baby.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the leg infection was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.
A short time later, on the 12th of November, Stephanie gave birth to a baby girl weighing a small weight – born before term, small but alive.
When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her dealer would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.
The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to medical equipment, so tiny she thought she would hurt her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What is our future?’” 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.
Medical personnel told her about a care center, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In many parts of America, where a baby is identified with newborn addiction symptoms every 18 minutes, 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 the care home is showing an important truth: when families are kept intact, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to pick her up.
She left the medical center still in recovery, anxious and doubtful about what would happen next.
At the facility, Stephanie still feared that authorities would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and separate them.
For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about enduring. Drugs came first; reliance came last.
Stephanie had a single companion, but even that bond was fragile. The people she loved always found ways to let her down. She was unable to value herself, let alone anyone else.
Each day, staff from Maddie’s Place drove her to a recovery program, provided orally. Gradually, she was beginning recovery.
She utilized each moment 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 sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all typical problems for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in wonder of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a pompom on her head, seated on the ground with the exit nearby. She is lean. Her posture is humble so you do not see her expression. She is presenting her daughter on her knee for the other kids to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if they could.
“In the future,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that newborns require care, then I was able. I could parent.”
Approaches for managing infants affected by substances have been available for years.
The Finnegan NAS scale was established in 1975|
