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 medical facility after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and vomited.
Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to find a way to become sober and have this baby.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was critical, 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.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a drug that alleviates cravings and is frequently utilized in rehabilitation.
A short time later, on a day in November 2022, Stephanie had a daughter weighing 4lb 8oz – early, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her final administration of fentanyl had been provided shortly before she gave birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her bond with her newborn would make her stop using only led to increased guilt and negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to medical equipment, so small she thought she would harm her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt 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 a care center, a unique recovery environment where mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, results get better, custody cases decrease and future expenses reduce.
It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to bring her to the facility.
She left the medical center still in withdrawal, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could enter and separate them.
For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Substances came first; trust came last.
Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to care for herself, not to mention anyone else.
Each day, staff from the center transported her to a treatment center, given as medication. Slowly, she was starting to get clean.
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 obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I was capable. I could be a mom.
During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, came over with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in awe 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 keeps a photo of the moment. She is dressed in casual attire, a cap with a decoration on her head, resting on the floor with the entryway at her back. She is thin. Her face is downcast so you cannot see her face. She is lifting the baby on her knee for the other kids to see and they are crowding near, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith 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 be a mom.”
Methods to address babies with exposure have been available for years.
The evaluation method was developed in 1975|
