Fentanyl Addiction During Pregnancy: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother arrived at the medical facility after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and became sick.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she had to return to get high again. She thought she still had a month remaining to plan her recovery and deliver her child.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the doctors would not let her go: the leg infection was critical, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.
A short time later, on the 12th of November, Stephanie delivered a infant weighing 4lb 8oz – premature, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been administered a few hours prior to birth.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her dealer declined to supply to her when she became clearly expecting.
“But I couldn’t,” she said. “I required assistance.”
The widespread belief that her love for her baby would make her quit only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The infant was moved to the NICU. When Stephanie eventually visited her, she was hooked up to medical equipment, so little she thought she would break her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
After two days she decided to give her child the name Izzie, after the attendant who showed compassion to her.
Hospital staff told her about a specialized facility, a innovative treatment home where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is found to have newborn addiction symptoms frequently, infants are still rushed to special care and medicated while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when mothers and babies stay together, outcomes improve, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage 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 detox, anxious and doubtful about what would happen next.
At the facility, Stephanie still was concerned that child services would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could enter and take her baby away.
For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Substances came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The people she loved always found ways to let her down. She did not know how to value herself, not to mention anyone else.
Every day, staff from the facility transported her to a clinic for methadone, provided orally. Over time, she was embracing sobriety.
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 intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an specialist – all common issues for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I could do this. I would become a mother.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, came over with her own family in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She has an image of the moment. She is clad in casual attire, a cap with a bobble on her head, resting on the floor with the exit nearby. She is lean. Her face is downcast so you do not see her expression. She is holding Izzie up on her knee for the other kids to see and they are gathered around, admiring and touching to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I would become a mother.”
Approaches for managing drug-exposed newborns have been used for a long time.
The Finnegan NAS scale was developed in 1975|
