She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Rescued Both Lives.
Pregnant and experiencing intense discomfort, a woman named Stephanie went to the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had built in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had used fentanyl before coming to the ER and had just enough time to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and deliver her child.
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 condition in her limbs was serious, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in addiction recovery.
A short time later, on the 12th of November, Stephanie delivered a daughter weighing a small weight – early, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” 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 sought recovery repeatedly before birth, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.
“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 greater shame and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.
The baby was taken to the NICU. When Stephanie eventually visited her, she was connected to medical equipment, so little she thought she would harm her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the nurse who had been so kind to her.
Medical personnel told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.
In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a small, growing network of centers like the care home is demonstrating a key fact: when parents and infants remain united, outcomes improve, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.
She left the medical center still in recovery, anxious and doubtful about what would happen next.
At the care center, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could enter and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about enduring. Substances 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 cause pain. She was unable to care for herself, much less anyone else.
Daily, staff from the center drove her to a recovery program, administered in pill form. Slowly, she was beginning recovery.
She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is clad in casual attire, a beanie with a pompom on her head, resting on the floor with the door behind her. She is thin. Her posture is humble so you cannot see her face. She is holding Izzie up on her knee for the young ones to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the mothers: “Where are all the dads?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if possible.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and the specialist made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could be a mom.”
Approaches for managing babies with exposure have been available for years.
The Finnegan NAS scale was created in 1975|
