She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Rescued Both Lives.
Eight months pregnant and in severe pain, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She leaned over the bed and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she needed to go home to get high again. She thought she still had a month remaining to find a way to become sober and have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the doctors would not let her go: the infection in her legs was severe, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie gave birth to a daughter weighing just over four pounds – born before term, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been administered four hours before delivery.
She felt ill. Not ready for motherhood. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt without value, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her recover only led to increased guilt and self-harm, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the special care nursery. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would hurt her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain 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.
Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.
In much of the US, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, custody cases decrease and future expenses reduce.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to collect her.
She left the medical center still in recovery, scared and uncertain about what would follow.
At the care center, Stephanie still worried that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any time, someone could arrive and separate them.
For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about survival. Addiction came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to let her down. She lacked the ability to value herself, not to mention anyone else.
Daily, staff from the facility drove her to a treatment center, provided orally. Gradually, she was beginning recovery.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an specialist – all frequent conditions for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.
On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in admiration of the small baby 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 gray knit hat with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.
One child, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could parent.”
Approaches for managing drug-exposed newborns have been used for a long time.
The assessment tool was created in 1975|
