She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Saved Them Both.
Pregnant and experiencing intense discomfort, the expectant mother visited the ER after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had built in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She slumped forward and became sick.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”
She had taken the drug 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 a month remaining to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would not survive.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.
Five days later, on 12 November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – early, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her previous intake of fentanyl had been given shortly before she gave birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt worthless, berating herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The common assumption that her bond with her newborn would make her stop using only led to deeper self-loathing and self-abuse, a trigger for her to return to drugs. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.
The infant was moved to the NICU. When Stephanie at last met her, she was connected to tubes and leads, so little she thought she would hurt her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘How will I care for 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 nurse who had been so kind to her.
Hospital staff told her about a care center, a innovative treatment home where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with infant withdrawal condition regularly, 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 families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.
It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to bring her to the facility.
She departed the institution still in detox, fearful and unsure about what would come next.
At the care center, Stephanie still feared that child services would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter and remove her child.
For the first two weeks, 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 survival. Substances came first; trust 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 lacked the ability to value herself, let alone anyone else.
Every day, staff from the facility drove her to a clinic for methadone, given as medication. Over time, she was embracing sobriety.
She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care 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 heightened sensory issues and required an professional – all frequent conditions for babies exposed to substances.
When a child recognizes these infants need affection, then I found the strength. I would become a mother.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a mentor, stopped by with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a decoration on her head, seated on the ground with the entryway at her back. She is thin. Her face is downcast so you cannot see her face. She is presenting her daughter on her lap for the children to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “What about the fathers?” 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’m going to be the best dad ever. I will teach them about love.”
Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I would become a mother.”
Methods to address drug-exposed newborns have existed for decades.
The assessment tool was created in 1975|
