She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother arrived at the hospital emergency room after her infection worsened up her legs. Without a job or home, estranged from her family, she lived in a shed she had built in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and threw up.
Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”
She had taken the drug before coming to the ER and had only a brief window to get treated before she needed to go home to get high again. She thought she still had four weeks left to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was staying put.
“Yes, I am,” Stephanie said.
But the doctors would not let her go: the infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.
Five days later, on the 12th of November, Stephanie delivered a baby girl weighing just over four pounds – premature, tiny yet healthy.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been provided a few hours prior to birth.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she failed. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became visibly pregnant.
“However, I failed,” she said. “I needed help.”
The widespread belief that her bond with her newborn would make her recover only led to greater shame and self-harm, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would break her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to give her child the name the same as her nurse, after the nurse who had been so kind to her.
Hospital staff told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, results get better, fewer children enter care and overall savings increase.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to bring her to the facility.
She left the medical center still in detox, fearful and unsure about what would come next.
At the care center, Stephanie still was concerned that authorities would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could walk in and separate them.
For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about enduring. Substances came first; reliance 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 was unable to care for herself, let alone anyone else.
Each day, staff from the center took her to a clinic for methadone, provided orally. Slowly, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a gray knit hat with a decoration on her head, resting on the floor with the exit nearby. She is thin. Her face is downcast so you miss her features. She is presenting her daughter on her leg for the other kids to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the parents: “Why are there no men?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I would become a mother.”
Methods to address drug-exposed newborns have been available for years.
The evaluation method was developed in 1975|
