She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother went to the ER after her infection worsened up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she had to return to use once more. She thought she still had a month remaining to find a way to become sober and deliver her child.
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 condition in her limbs was severe, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie gave birth to a daughter weighing just over four pounds – premature, small but alive.
When the attendant inquired if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt unwell. Not ready for motherhood. Unworthy.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt without value, criticizing herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her source would not provide to her when she became visibly pregnant.
“However, I failed,” she said. “I required assistance.”
The pervasive expectation that her affection for her child would make her stop using only led to deeper self-loathing and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.
The baby was taken to the special care nursery. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
After two days she decided to name her baby after her caregiver, after the professional who provided support to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and given drugs while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, results get better, fewer children enter care and overall savings increase.
It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.
She stepped out of the hospital still in withdrawal, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still worried that child services would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could arrive and remove her child.
For the initial fortnight, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about survival. Addiction came first; faith came last.
Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to let her down. She lacked the ability to value herself, let alone anyone else.
Each day, staff from the center transported her to a clinic for methadone, administered in pill form. Slowly, she was beginning recovery.
She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an occupational therapist – all typical problems for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. An advocate, a peer support specialist, visited with her own family in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the tiny infant 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 keeps a photo of the moment. She is clad in black pants and a hoodie, a gray knit hat with a pompom on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her knee for the children to see and they are standing close, fawning and reaching out to the baby.
Jacob, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could parent.”
Methods to address infants affected by substances have existed for decades.
The Finnegan NAS scale was developed in 1975|
