She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, the expectant mother arrived at the ER after an infection began spreading up her legs. Without a job or home, estranged from her family, she resided in a small structure she had constructed in a companion's property. She was also addicted to fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and threw up.
Stephanie finally broke down. “I have to get out of here. I have to go home and get high.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she needed to go home to relapse. She thought she still had a month remaining to plan her recovery and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie delivered a baby girl weighing a small weight – born before term, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided a few hours prior to birth.
She felt unwell. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she failed. She felt hopeless, blaming herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her dealer would not provide to her when she became obviously with child.
“Yet I was unable,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her quit only led to deeper self-loathing and self-harm, a cause for her to relapse. 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 small she thought she would hurt her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Two days later she decided to call her daughter 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 mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is found to have infant withdrawal condition frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to bring her to the facility.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would follow.
At the facility, Stephanie still worried that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any point, someone could arrive and take her baby away.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to let her down. She was unable to care for herself, much less anyone else.
Every day, staff from the center transported her to a treatment center, provided orally. Gradually, she was beginning recovery.
She devoted all her time beyond therapy 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 dietary support. She also had sensory challenges and required an specialist – all frequent conditions for babies exposed to substances.
Seeing that even a young person understands the need for care, then I could do this. 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 mentor, came over with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a bobble on her head, seated on the ground with the entryway at her back. She is slender. Her posture is humble so you do not see her expression. She is lifting the baby on her lap for the young ones to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could parent.”
Tools for treating drug-exposed newborns have been used for a long time.
The Finnegan NAS scale was established in 1975|