Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother went to the ER after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and became sick.
Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and deliver her child.
The attending nurse disagreed. 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, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.
A short time later, on the 12th of November, Stephanie gave birth to a infant weighing just over four pounds – premature, little but surviving.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been provided shortly before she gave birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her dealer would not provide to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her bond with her newborn would make her stop using only led to deeper self-loathing and negative self-talk, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was hooked up to tubes and leads, so small she thought she would break her. Cradling her initially, she felt detached. “I just stared at 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 professional who provided support to her.
Hospital staff told her about a care center, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.
In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, outcomes improve, fewer children enter care and overall savings increase.
It took Stephanie some time to build confidence to call, but she finally did. After verifying her eligibility for the program, two staff members came to pick her up.
She stepped out of the hospital still in detox, scared and uncertain about what would come next.
At the care center, Stephanie still feared that child services would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could arrive and take her baby away.
For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to let her down. She did not know how to value herself, not to mention anyone else.
Every day, staff from the center drove her to a recovery program, administered in pill form. Slowly, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I could be a mom.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She has an image of the moment. She is clad in casual attire, a gray knit hat with a pompom on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you do not see her expression. She is lifting the baby on her lap for the young ones to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the moms: “What about the fathers?” The parents responded that the fathers had obligations, engaged elsewhere, that they would be there if they could.
“When I have kids,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I could be a mom.”
Approaches for managing babies with exposure have existed for decades.
The evaluation method was developed in 1975|
