She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.
Pregnant and experiencing intense discomfort, the expectant mother arrived at the ER after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and threw up.
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 needed to go home to get high again. She thought she still had several weeks to figure out how to get clean and have this baby.
The medical professional intervened. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the medical facility declined to release her: the condition in her limbs was severe, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.
After five days, on 12 November 2022, Stephanie gave birth to a daughter weighing a small weight – early, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been administered shortly before she gave birth.
She felt sick. Unprepared to be a mother. Unworthy.
Stephanie had sought recovery multiple times while expecting, and felt awful each time she relapsed. She felt worthless, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her source refused to sell to her when she became clearly expecting.
“However, I failed,” she said. “I had to seek support.”
The common assumption that her bond with her newborn would make her stop using only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.
The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to medical equipment, so small she thought she would break her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
Following a brief period she decided to name her baby Izzie, after the attendant who showed compassion to her.
Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.
In much of the US, where a baby is diagnosed with infant withdrawal condition regularly, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, results get better, custody cases decrease and overall savings increase.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, two staff members came to collect her.
She stepped out of the hospital still in detox, anxious and doubtful about what would happen next.
At the care center, Stephanie still was concerned that authorities would come seize her child – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could walk in and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”
Survival outdoors, she said, was about getting by. Drugs came first; faith came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She was unable to love herself, let alone anyone else.
Every day, staff from Maddie’s Place transported her to a recovery program, given as medication. Slowly, she was beginning recovery.
She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an professional – all frequent conditions for babies exposed to substances.
Seeing that even a young person understands the need for care, then I could do this. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where those still using can come for monitored interactions with their babies. An advocate, a mentor, stopped by with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The young ones stared in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a cap with a decoration on her head, resting on the floor with the exit nearby. She is thin. Her head is tilted forward so you cannot see her face. She is lifting the baby on her knee for the other kids to see and they are crowding near, showing interest to the baby.
Jacob, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could be a mom.”
Methods to address babies with exposure have been used for a long time.
The Finnegan NAS scale was created in 1975|
