She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother went to the ER after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had assembled in a companion's property. She was also dependent on fentanyl.
As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and get high.”
She had used fentanyl before arriving at the hospital and had just enough time to get treated before she had to return to get high again. She thought she still had four weeks left to find a way to become sober and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would not survive.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.
After five days, on a day in November 2022, Stephanie had a infant weighing 4lb 8oz – premature, small but alive.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.
She felt sick. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt worthless, berating herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her source refused to sell to her when she became clearly expecting.
“Yet I was unable,” she said. “I had to seek support.”
The widespread belief that her bond with her newborn would make her recover only led to greater shame and self-harm, a cause for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the special care nursery. When Stephanie at last met her, she was attached to medical equipment, so little she thought she would harm her. Cradling her initially, 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 name her baby Izzie, after the attendant who showed compassion to her.
Medical personnel told her about a specialized facility, a unique recovery environment where women and their babies are supported as a unit, not apart.
In many parts of America, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and medicated while their mothers face parental assessments. But a developing system of centers like this facility is proving a simple point: when families are kept intact, outcomes improve, fewer children enter care and future expenses reduce.
It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to bring her to the facility.
She departed the institution still in withdrawal, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still was concerned that child services would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could walk in and separate them.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. Substances came first; reliance came last.
Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to care for herself, much less anyone else.
Each day, staff from the center drove her to a clinic for methadone, provided orally. Over time, she was beginning recovery.
She utilized each moment when not in sessions 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 severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an specialist – all typical problems for babies affected by withdrawal.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in awe of the little newborn 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 holds a picture of the moment. She is clad in black pants and a hoodie, a beanie with a decoration on her head, seated on the ground with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is lifting the baby on her lap for the children to see and they are crowding near, admiring and touching to the baby.
One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, engaged elsewhere, that they would be there given the chance.
“In the future,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and Bunch-Smith looked at each other. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could be a mom.”
Approaches for managing babies with exposure have been used for a long time.
The assessment tool was developed in 1975|
