She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother visited the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also hooked on fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and vomited.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before seeking medical help and had only a brief window to get treated before she had to return to relapse. She thought she still had four weeks left to plan her recovery and give birth.
The medical professional intervened. She told Stephanie she was staying put.
“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, Izzie, warned her: if she walked out, she and her baby would be at risk of death.
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 drug that alleviates cravings and is frequently utilized in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – born before term, small but alive.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been given shortly before she gave birth.
She felt ill. Ill-equipped for parenting. Not fit.
Stephanie had sought recovery several times during pregnancy, and felt awful each time she was unsuccessful. She felt hopeless, berating herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her supplier would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I needed help.”
The widespread belief that her affection for her child would make her quit only led to greater shame and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.
The baby was taken to the NICU. When Stephanie finally saw her her, she was connected to tubes and leads, so tiny she thought she would harm her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.
Hospital staff told her about a care center, 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 identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when families are kept intact, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.
She departed the institution still in detox, anxious and doubtful about what would come next.
At the care center, Stephanie still worried that child services would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could walk in and take her baby away.
For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Substances came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She was unable to care for herself, let alone anyone else.
Each day, staff from the facility drove her to a treatment center, provided orally. Gradually, she was starting to get clean.
She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had increased sensitivity 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 found the strength. I could parent.
During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. An advocate, a mentor, came over with her own children in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”
She has an image of the moment. She is clad 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 lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if possible.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I would become a mother.”
Tools for treating drug-exposed newborns have existed for decades.
The evaluation method was developed in 1975|
