She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother visited the medical facility after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she resided in a small structure she had constructed 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 became sick.
Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she had to return to get high again. She thought she still had several weeks to plan her recovery and give birth.
The nurse had other ideas. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she walked out, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.
After five days, on a day in November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – early, small but alive.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been provided four hours before delivery.
She felt ill. Ill-equipped for parenting. Unworthy.
Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her supplier declined to supply to her when she became clearly expecting.
“However, I failed,” she said. “I needed help.”
The pervasive expectation that her love for her baby would make her recover only led to deeper self-loathing and negative self-talk, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to tubes and leads, so little she thought she would break her. Embracing her at last, she felt empty. “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.
Two days later she decided to name her baby Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like the care home is proving a simple point: when families are kept intact, outcomes improve, custody cases decrease and long-term costs decline.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to collect her.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would happen next.
At Maddie’s Place, Stephanie still was concerned that CPS would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could arrive and separate them.
For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about getting by. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to let her down. She was unable to value herself, much less anyone else.
Every day, staff from the facility transported her to a recovery program, administered in pill form. Slowly, she was beginning recovery.
She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care 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 heightened sensory issues and required an specialist – all typical problems for babies affected by withdrawal.
When a child recognizes these infants need affection, then I was capable. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. An advocate, a mentor, came over with her own children in tow to deliver baked goods. They all crowded near 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. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She keeps a photo of the moment. She is wearing 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 slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her knee for the other kids to see and they are standing close, showing interest to the baby.
Jacob, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, called away to other tasks, 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 exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I would become a mother.”
Approaches for managing babies with exposure have been available for years.
The assessment tool was created in 1975|
