She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother visited the ER after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and threw up.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and take a hit.”
She had used fentanyl before seeking medical help and had only a brief window to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the infection in her legs was serious, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.
After five days, on the 12th of November, Stephanie delivered a daughter weighing just over four pounds – born before term, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been given a few hours prior to birth.
She felt sick. Not ready for motherhood. Undeserving.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.
“However, I failed,” she said. “I had to seek support.”
The pervasive expectation that her love for her baby would make her stop using only led to deeper self-loathing and self-abuse, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.
The newborn was transferred to the NICU. When Stephanie at last met her, she was hooked up to medical equipment, so little she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to give her child the name Izzie, after the nurse who had been so kind to her.
Medical personnel told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.
In many parts of America, where a baby is found to have infant withdrawal condition regularly, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is showing an important truth: when parents and infants remain united, results get better, foster placements fall and future expenses reduce.
It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to collect her.
She departed the institution still in recovery, scared and uncertain about what would come next.
At the facility, Stephanie still was concerned that child services would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could walk in and separate them.
For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about enduring. Drugs came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She did not know how to care for herself, let alone 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 devoted all her time when not in sessions 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 sensory challenges and required an professional – all frequent conditions for babies born with NAS.
If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. A support specialist, a mentor, came over with her own family in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She keeps a photo of the moment. She is wearing casual attire, a cap with a decoration on her head, resting on the floor with the door behind her. She is thin. Her head is tilted forward so you cannot see her face. She is lifting the baby on her knee for the children to see and they are crowding near, admiring and touching to the baby.
Jacob, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if possible.
“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could be a mom.”
Methods to address infants affected by substances have been used for a long time.
The Finnegan NAS scale was created in 1975|
