Fentanyl Addiction During Pregnancy: 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. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a companion's property. She was also hooked on fentanyl.
As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and became sick.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
She had used fentanyl before arriving at the hospital and had sufficient opportunity 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 have this baby.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.
A short time later, on the 12th of November, Stephanie gave birth to a baby girl weighing 4lb 8oz – early, small but alive.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been provided four hours before delivery.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, berating herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I had to seek support.”
The common assumption that her affection for her child would make her recover only led to deeper self-loathing and self-abuse, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was attached to monitors, so tiny she thought she would harm her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is identified with 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 this facility is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to collect her.
She departed the institution still in recovery, anxious and doubtful about what would follow.
At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could walk in and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about survival. Addiction came first; faith came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She lacked the ability to love herself, much less anyone else.
Each day, staff from Maddie’s Place transported her to a recovery program, administered in pill form. Gradually, she was starting to get clean.
She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all common issues for babies exposed to substances.
Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.
On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a peer support specialist, visited with her own five kids in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She has an image of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a decoration on her head, resting on the floor with the exit nearby. She is thin. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the children to see and they are gathered around, admiring and touching to the baby.
A young boy, eight, asked the mothers: “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 plan to be a great parent. They will know they are valued.”
Stephanie and her companion looked at each other. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I would become a mother.”
Tools for treating babies with exposure have existed for decades.
The assessment tool was created in 1975|
