She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the ER after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also hooked on fentanyl.
As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and threw up.
Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”
She had used fentanyl before coming to the ER and had only a brief window to get treated before she had to return to get high again. She thought she still had four weeks left to figure out how to get clean and give birth.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the hospital refused to discharge her: the infection in her legs was critical, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm 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 substance abuse treatment.
A short time later, on a day in November 2022, Stephanie had a infant weighing 4lb 8oz – born before term, tiny yet healthy.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.
She felt sick. Ill-equipped for parenting. Unworthy.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she failed. She felt worthless, berating herself for not being able to do the impossible. An OBGYN told her to “only” stop using. Even her supplier would not provide to her when she became visibly pregnant.
“However, I failed,” she said. “I required assistance.”
The widespread belief that her affection for her child would make her recover only led to increased guilt and negative self-talk, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.
The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was hooked up to medical equipment, so small she thought she would hurt her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to name her baby the same as her nurse, after the professional who provided support to her.
Nurses and doctors told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.
In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face child-protection investigations. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, custody cases decrease and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After verifying her eligibility for the program, care providers came to pick her up.
She left the medical center still in withdrawal, anxious and doubtful about what would happen next.
At the facility, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could arrive and take her baby away.
For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about getting by. Addiction came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She did not know how to care for herself, let alone anyone else.
Every day, staff from the facility took her to a clinic for methadone, administered in pill form. Slowly, she was beginning recovery.
She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all typical problems for babies affected by withdrawal.
Seeing that even a young person understands the need for care, then I could do this. I could parent.
On a day prior to the holiday, Stephanie remained in the shared space, where those still using can come for supervised visits with their babies. A support specialist, a mentor, stopped by with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is lifting the baby on her leg for the other kids to see and they are standing close, admiring and touching to the baby.
Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the dads were busy, engaged elsewhere, that they would be there given the chance.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I would become a mother.”
Tools for treating drug-exposed newborns have been available for years.
The Finnegan NAS scale was created in 1975|
