She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother arrived at the ER after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had built in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and vomited.
Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”
She had consumed opioids before seeking medical help and had only a brief window to get treated before she needed to go home to relapse. She thought she still had four weeks left to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“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 amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.
Five days later, on 12 November 2022, Stephanie delivered a baby girl weighing just over four pounds – early, tiny yet healthy.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been provided four hours before delivery.
She felt unwell. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery multiple times while expecting, and felt terrible each time she relapsed. She felt without value, criticizing herself for not being able to achieve the unattainable. An obstetrician 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 pervasive expectation that her love for her baby would make her stop using only led to greater shame and self-harm, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to monitors, so tiny she thought she would hurt her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the nurse who had been so kind to her.
Medical personnel told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to collect her.
She left the medical center still in recovery, anxious and doubtful about what would come next.
At Maddie’s Place, Stephanie still was concerned that authorities would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could walk in and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Addiction came first; trust came last.
Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to let her down. She was unable to love herself, not to mention anyone else.
Daily, staff from the center transported her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.
She utilized each moment when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all typical problems for babies exposed to substances.
Seeing that even a young person understands the need for care, then I could do this. I would become a mother.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She has an image of the moment. She is dressed in casual attire, a cap with a bobble on her head, seated on the ground with the exit nearby. She is lean. Her face is downcast so you do not see her expression. She is lifting the baby on her knee for the young ones to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could parent.”
Methods to address drug-exposed newborns have been used for a long time.
The assessment tool was created in 1975|
