She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
In her eighth month of pregnancy and suffering, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had built 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 leaned over the bed and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had four weeks left to plan her recovery and give birth.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, 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 switched to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.
After five days, on a day in November 2022, Stephanie gave birth to a infant weighing a small weight – premature, tiny yet healthy.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her final administration of fentanyl had been administered shortly before she gave birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery repeatedly before birth, and felt horrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her supplier would not provide to her when she became clearly expecting.
“However, I failed,” she said. “I needed help.”
The widespread belief that her love for her baby would make her stop using only led to greater shame and self-harm, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would break her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.
In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is proving a simple point: when parents and infants remain united, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, two staff members came to bring her to the facility.
She left the medical center still in recovery, fearful and unsure about what would follow.
At the facility, Stephanie still feared that CPS would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could enter and separate them.
For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Substances came first; trust came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to care for herself, not to mention anyone else.
Each day, staff from the center drove her to a recovery program, administered in pill form. Over time, she was embracing sobriety.
She spent every minute 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 obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies affected by withdrawal.
When a child recognizes these infants need affection, then I found the strength. I could be a mom.
On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her leg for the young ones to see and they are standing close, admiring and touching to the baby.
One child, eight, asked the parents: “Where are all the dads?” The parents responded that the dads were busy, engaged elsewhere, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could parent.”
Approaches for managing babies with exposure have existed for decades.
The Finnegan NAS scale was established in 1975|
