She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother arrived at the ER after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had constructed in a friend’s yard. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and became sick.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had several weeks to plan her recovery and deliver her child.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I will go,” Stephanie said.
But the hospital refused to discharge her: the leg infection was serious, but physicians found she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.
Five days later, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – early, small but alive.
When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her pain relief did not work, her final administration of fentanyl had been administered shortly before she gave birth.
She felt sick. Unprepared to be a mother. Not fit.
Stephanie had tried to get clean multiple times while expecting, and felt awful each time she failed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her love for her baby would make her quit only led to deeper self-loathing and self-harm, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to tubes and leads, 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 remained uncertain she wanted to be her mother.
Two days later she decided to call her daughter after her caregiver, after the professional who provided support to her.
Nurses and doctors told her about a care center, 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 diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to collect her.
She departed the institution still in detox, anxious and doubtful about what would happen next.
At the facility, Stephanie still worried that child services would come remove her daughter – even though she was not sure she wanted to keep her. The concern persisted: that at any point, someone could enter and take her baby away.
For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about enduring. Drugs came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to hurt her. She did not know how to love herself, let alone anyone else.
Every day, staff from the facility took her to a recovery program, given as medication. Over time, she was starting to get clean.
She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an specialist – all typical problems for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I would become a mother.
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 mentor, visited with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a decoration on her head, resting on the floor with the door behind her. She is slender. Her posture is humble so you cannot see her face. She is presenting her daughter on her leg for the children to see and they are crowding near, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I plan to be a great parent. I will teach them about love.”
Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I was able. I would become a mother.”
Approaches for managing babies with exposure have existed for decades.
The Finnegan NAS scale was developed in 1975|
