She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had assembled in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”
She had used fentanyl before arriving at the hospital and had just enough time to get treated before she had to return to get high again. She thought she still had four weeks left to figure out how to get clean and deliver her child.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was serious, but doctors had discovered 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 every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
Five days later, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – premature, small but alive.
When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided four hours before delivery.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had sought recovery multiple times while expecting, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her source would not provide to her when she became visibly pregnant.
“However, I failed,” she said. “I required assistance.”
The pervasive expectation that her love for her baby would make her stop using only led to increased guilt and self-harm, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to tubes and leads, so little she thought she would hurt her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.
Medical personnel told her about a specialized facility, 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 diagnosed with infant withdrawal condition every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like the care home is proving a simple point: when mothers and babies stay together, results get better, fewer children enter care and overall savings increase.
It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to pick her up.
She departed the institution still in detox, anxious and doubtful about what would come next.
At the care center, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and remove her child.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Substances came first; reliance came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She was unable to value herself, not to mention anyone else.
Every day, staff from Maddie’s Place drove her to a treatment center, provided orally. Slowly, she was embracing sobriety.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I was capable. I could be a mom.
One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for supervised visits with their babies. An advocate, a recovery coach, 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. “My past did not matter to them. None of those things mattered to them.”
She has an image of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a bobble on her head, seated on the ground with the door behind her. She is thin. Her face is downcast so you do not see her expression. She is holding Izzie up on her leg for the other kids to see and they are gathered around, showing interest 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 possible.
“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could be a mom.”
Methods to address infants affected by substances have existed for decades.
The Finnegan NAS scale was created in 1975|
