Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had constructed in a companion's property. She was also addicted to fentanyl.
As doctors treated her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”
She had consumed opioids before seeking medical help and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to figure out how to get clean and have this baby.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the doctors would not let her go: the infection in her legs was serious, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.
Five days later, on the 12th of November, Stephanie delivered a baby girl weighing a small weight – born before term, little but surviving.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been given shortly before she gave birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery multiple times while expecting, and felt awful each time she was unsuccessful. She felt without value, berating herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“Yet I was unable,” 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 self-harm, 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 infant was moved to the special care nursery. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would hurt her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.
Nurses and doctors told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.
In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like the care home is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to pick her up.
She stepped out of the hospital still in withdrawal, anxious and doubtful about what would come next.
At the facility, Stephanie still feared that CPS would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and remove her child.
For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Homelessness, she said, was about getting by. Substances came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to hurt her. She lacked the ability to love herself, much less anyone else.
Each day, staff from Maddie’s Place took her to a clinic for methadone, given as medication. Slowly, she was embracing sobriety.
She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – 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 could be a mom.
One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. A support specialist, a peer support specialist, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She has an image of the moment. She is clad in black pants and a hoodie, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is slender. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her knee for the young ones to see and they are standing close, showing interest to the baby.
A young boy, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if they could.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I would become a mother.”
Methods to address drug-exposed newborns have been available for years.
The evaluation method was created in 1975|
