Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, the expectant mother went to the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had built in a companion's property. She was also hooked on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and threw up.
Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids before coming to the ER 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 medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the leg infection was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
A short time later, on the 12th of November, Stephanie delivered a baby girl weighing 4lb 8oz – premature, small but alive.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been given four hours before delivery.
She felt unwell. Unprepared to be a mother. Unworthy.
Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she failed. She felt without value, blaming herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her supplier declined to supply to her when she became clearly expecting.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her stop using only led to greater shame and negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to tubes and leads, so little she thought she would break her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
After two days she decided to call her daughter Izzie, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, 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 identified with newborn addiction symptoms every 18 minutes, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when mothers and babies stay together, outcomes improve, custody cases decrease and overall savings increase.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in detox, scared and uncertain about what would happen next.
At the facility, Stephanie still feared that child services would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could walk in and remove her child.
For the beginning period, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about getting by. Substances came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else.
Daily, staff from Maddie’s Place took her to a clinic for methadone, administered in pill form. 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 adverse reactions to milk and severe digestive problems. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues 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 parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in wonder of the tiny infant 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 holds a picture of the moment. She is dressed in black pants and a hoodie, a cap with a bobble on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are crowding near, showing interest to the baby.
One child, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, handling responsibilities, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and her companion exchanged glances. “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 babies with exposure have been available for years.
The Finnegan NAS scale was created in 1975|
