Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother went to the ER after her infection worsened up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”
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 use once more. She thought she still had four weeks left to plan her recovery and give birth.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was critical, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.
A short time later, on 12 November 2022, Stephanie had a daughter weighing a small weight – born before term, small but alive.
When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.
She felt sick. Not ready for motherhood. Unworthy.
Stephanie had sought recovery multiple times while expecting, and felt awful each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source declined to supply to her when she became obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The widespread belief that her affection for her child would make her recover only led to deeper self-loathing and self-harm, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a long-term illness.
The baby was taken to the NICU. When Stephanie finally saw her her, she was hooked up to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure 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.
Nurses and doctors told her about a specialized facility, a new kind of care center where women and their babies are supported as a unit, not apart.
In numerous states, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, recovery succeeds, foster placements fall and overall savings increase.
It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to collect her.
She departed the institution still in recovery, scared and uncertain about what would come next.
At Maddie’s Place, Stephanie still feared that CPS would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could arrive 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 survival. Substances came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to let her down. She did not know how to value herself, let alone anyone else.
Daily, staff from the center took her to a recovery program, administered in pill form. Slowly, she was embracing sobriety.
She devoted all her time when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for supervised visits with their babies. An advocate, a recovery coach, visited with her own children in tow to bring treats. They all gathered around 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. They focused only on the baby.”
She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the young ones to see and they are gathered around, fawning and reaching out to the baby.
Jacob, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if possible.
“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could parent.”
Approaches for managing infants affected by substances have been available for years.
The evaluation method was developed in 1975|
