Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child 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. Without a job or home, cut off from her relatives, she lived in a shed she had assembled in a acquaintance's garden. She was also hooked on fentanyl.
As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and vomited.
Stephanie eventually collapsed. “I need to leave. I have to go home and get high.”
She had used fentanyl before coming to the ER and had just enough time to get treated before she had to return to get high again. She thought she still had several weeks to figure out how to get clean and deliver her child.
The nurse had other ideas. She told Stephanie she was not going anywhere.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.
A short time later, on the 12th of November, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, small but alive.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.
She felt sick. Unprepared to be a mother. Undeserving.
Stephanie had sought recovery repeatedly before birth, and felt awful each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her supplier declined to supply to her when she became visibly pregnant.
“However, I failed,” she said. “I had to seek support.”
The widespread belief that her bond with her newborn would make her quit only led to increased guilt and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.
The infant was moved to the special care nursery. When Stephanie eventually visited her, she was attached to medical equipment, so tiny she thought she would break her. Embracing her at last, she felt empty. “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 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 innovative treatment home where women and their babies are supported as a unit, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is proving a simple point: when families are kept intact, recovery succeeds, custody cases decrease and long-term costs decline.
It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to pick her up.
She left the medical center still in detox, scared and uncertain about what would happen next.
At the care center, Stephanie still was concerned that CPS would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and separate them.
For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”
Life on the streets, she said, was about getting by. Addiction came first; trust came last.
Stephanie had a trusted ally, but even that connection was tenuous. The people she loved always found ways to hurt her. She did not know how to love herself, much less anyone else.
Each day, staff from the facility drove her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.
She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had sensory challenges and required an specialist – all common issues for babies born with NAS.
Seeing that even a young person understands the need for care, then I could do this. I could be a mom.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a recovery coach, came over with her own family in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”
She has an image of the moment. She is clad in casual attire, a gray knit hat with a bobble on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her lap for the children to see and they are crowding near, admiring and touching to the baby.
Jacob, eight, asked the parents: “What about the fathers?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if they could.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.”
Tools for treating babies with exposure have been used for a long time.
The assessment tool was developed in 1975|
