Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.

Eight months pregnant and in severe pain, the expectant mother went to the ER after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie ultimately gave in. “I need to leave. 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 had to return to use once more. She thought she still had a month remaining to find a way to become sober and deliver her child.

The nurse had other ideas. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the leg infection was serious, 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 not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

A short time later, on the 12th of November, Stephanie delivered a baby girl weighing 4lb 8oz – premature, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was numb. Her epidural had failed, her previous intake of fentanyl had been administered shortly before she gave birth.

She felt unwell. Unprepared to be a mother. Undeserving.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she relapsed. She felt hopeless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her supplier refused to sell to her when she became obviously with child.

“But I couldn’t,” 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 cause for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would harm her. Holding her for the first time, she felt empty. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to call her daughter Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a small, growing network 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 overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, a couple of employees came to collect her.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would come next.

At the care center, Stephanie still feared that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and remove her child.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about survival. Substances came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She did not know how to love herself, much less anyone else.

Every day, staff from the facility took her to a clinic for methadone, given as medication. Over time, she was beginning recovery.

She utilized each moment 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 intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all typical problems for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.

On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a peer support specialist, visited with her own children in tow to bring treats. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in awe of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She keeps a photo of the moment. She is clad in casual attire, a cap with a bobble on her head, seated on the ground with the exit nearby. She is slender. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her lap for the children to see and they are gathered around, admiring and touching to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if possible.

“When I have kids,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could be a mom.”

Methods to address babies with exposure have been used for a long time.

The evaluation method was developed in 1975|