She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, the expectant mother went to the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She slumped forward and threw up.
Stephanie finally broke down. “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 just enough time to get treated before she was compelled to leave to use once more. She thought she still had several weeks to figure out how to get clean and deliver her child.
The medical professional intervened. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, 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.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.
A short time later, on a day in November 2022, Stephanie gave birth to a infant weighing a small weight – early, tiny yet healthy.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.
She felt ill. Ill-equipped for parenting. Unworthy.
Stephanie had sought recovery repeatedly before birth, and felt horrible each time she relapsed. She felt hopeless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her source refused to sell 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 stop using only led to increased guilt and negative self-talk, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The baby was taken to the special care nursery. When Stephanie finally saw her her, she was connected to tubes and leads, so tiny she thought she would harm her. Embracing her at last, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to call her daughter the same as her nurse, after the nurse who had been so kind to her.
Hospital staff told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns 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 child-protection investigations. But a small, growing network of centers like the care home is showing an important truth: when parents and infants remain united, recovery succeeds, fewer children enter care and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to bring her to the facility.
She left the medical center still in withdrawal, anxious and doubtful about what would follow.
At the care center, Stephanie still worried that authorities would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any time, someone could enter and separate them.
For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Drugs came first; faith came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to let her down. She did not know how to care for herself, let alone anyone else.
Every day, staff from Maddie’s Place took her to a recovery program, administered in pill form. Over time, she was embracing sobriety.
She spent every minute beyond therapy 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 obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems for babies born with NAS.
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 individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by 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 small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She has an image of the moment. She is dressed in black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her head is tilted forward so you do not see her expression. She is lifting the baby on her lap for the children to see and they are crowding near, fawning and reaching out to the baby.
One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if they could.
“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”
Tools for treating drug-exposed newborns have existed for decades.
The Finnegan NAS scale was developed in 1975|
