She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Rescued Both Lives.
In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also hooked on fentanyl.
As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and became sick.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had taken the drug 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 figure out how to get clean and deliver her child.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the leg infection was critical, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, 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 symptoms could threaten her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
After five days, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – born before term, tiny yet healthy.
When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was numb. Her epidural had failed, her previous intake of fentanyl had been given four hours before delivery.
She felt unwell. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she was unsuccessful. She felt without value, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.
The newborn was transferred to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.
Medical personnel told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.
In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs 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 parents and infants remain united, outcomes improve, foster placements fall and overall savings increase.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She left the medical center still in recovery, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still feared that child services would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any time, someone could arrive and separate them.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to let her down. She did not know how to care for herself, let alone anyone else.
Every day, staff from the center transported her to a recovery program, given as medication. Slowly, 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 girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an specialist – all frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I could do this. I could parent.
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. A support specialist, a recovery coach, 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 kids looked amazed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She holds a picture 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 door behind her. She is lean. Her posture is humble so you miss her features. She is presenting her daughter on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.
One child, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there if possible.
“Once I become a parent,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I could parent.”
Approaches for managing drug-exposed newborns have been available for years.
The Finnegan NAS scale was developed in 1975|
