She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.
Eight months pregnant and in severe pain, a woman named Stephanie arrived at 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 built in a friend’s yard. She was also dependent on fentanyl.
As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and vomited.
Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”
She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she needed to go home to relapse. She thought she still had a month remaining to find a way to become sober and give birth.
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 leg infection was serious, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.
A short time later, on 12 November 2022, Stephanie delivered a infant weighing a small weight – born before term, small but alive.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt ill. Ill-equipped for parenting. Undeserving.
Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt without value, berating herself for not being able to achieve the unattainable. An doctor told her to “just” stop using. Even her supplier refused to sell to her when she became obviously with child.
“However, I failed,” she said. “I needed help.”
The widespread belief that her bond with her newborn would make her recover only led to deeper self-loathing and self-abuse, a impetus for her to return to drugs. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.
The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to monitors, so tiny she thought she would harm 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 name her baby Izzie, after the nurse who had been so kind to her.
Medical personnel told her about a care center, a innovative treatment home where women and their babies are cared for jointly, not apart.
In many parts of America, 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 the care home is showing an important truth: when mothers and babies stay together, results get better, foster placements fall and long-term costs decline.
It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to pick her up.
She departed the institution still in detox, scared and uncertain about what would happen next.
At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could arrive and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”
Homelessness, she said, was about getting by. Drugs came first; reliance came last.
Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to hurt her. She did not know how to care for herself, much less anyone else.
Each day, staff from the facility transported her to a recovery program, administered in pill form. Gradually, she was starting to get clean.
She devoted all her time outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all common issues for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I was capable. I could be a mom.
On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”
She has an image of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a pompom on her head, sitting on the wooden floor with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her leg for the other kids to see and they are crowding near, showing interest to the baby.
A young boy, eight, asked the moms: “Why are there no men?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there given the chance.
“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”
Approaches for managing babies with exposure have been used for a long time.
The evaluation method was developed in 1975|
