She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.
In her eighth month of pregnancy and suffering, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also hooked on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and became sick.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had several weeks to plan her recovery and have this baby.
The nurse had other ideas. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was severe, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.
A short time later, on 12 November 2022, Stephanie had a infant weighing just over four pounds – born before term, little but surviving.
When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.
She felt ill. Not ready for motherhood. Undeserving.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I needed help.”
The pervasive expectation that her affection for her child would make her quit only led to increased guilt and self-abuse, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.
The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
After two days she decided to name her baby Izzie, after the nurse who had been so kind to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.
In much of the US, where a baby is found to have newborn addiction symptoms frequently, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, fewer children enter care and long-term costs decline.
It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to pick her up.
She stepped out of the hospital still in recovery, scared and uncertain about what would follow.
At Maddie’s Place, Stephanie still worried that CPS would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and take her baby away.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to cause pain. She did not know how to value herself, not to mention anyone else.
Each day, staff from Maddie’s Place transported her to a recovery program, given as medication. Gradually, she was beginning recovery.
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 girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I was capable. I could parent.
On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own family in tow to drop off cookies. They all gathered around Stephanie, who was seated on the ground holding Izzie.
The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”
She has an image of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, resting on the floor 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 children to see and they are crowding near, fawning and reaching out to the baby.
One child, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”
Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could be a mom.”
Approaches for managing infants affected by substances have been used for a long time.
The evaluation method was established in 1975|
