She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Saved Them Both.
Eight months pregnant and in severe pain, a woman named Stephanie visited the ER after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had constructed in a companion's property. She was also hooked on fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and use drugs.”
She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had four weeks left to find a way to become sober and have this baby.
The medical professional intervened. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the condition in her limbs was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.
A short time later, on the 12th of November, Stephanie had a daughter weighing 4lb 8oz – born before term, small but alive.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been administered a few hours prior to birth.
She felt ill. Unprepared to be a mother. Undeserving.
Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An doctor told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.
“However, I failed,” she said. “I needed help.”
The common assumption that her affection for her child would make her quit only led to greater shame and self-abuse, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Two days later she decided to name her baby Izzie, after the attendant who showed compassion to her.
Hospital staff told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like this facility is showing an important truth: when mothers and babies stay together, results get better, custody cases decrease and long-term costs decline.
It took Stephanie some time to build confidence to call, but she finally did. 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 detox, anxious and doubtful about what would happen next.
At the care center, Stephanie still feared that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”
Homelessness, she said, was about survival. Substances came first; faith came last.
Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to let her down. 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, administered in pill form. Gradually, she was starting to get clean.
She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an professional – all typical problems for babies born with NAS.
Seeing that even a young person understands the need for care, then I was capable. I could parent.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a mentor, visited with her own children in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She has an image of the moment. She is dressed in casual attire, a cap with a pompom on her head, resting on the floor with the exit nearby. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are crowding near, showing interest to the baby.
One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if they could.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I would become a mother.”
Tools for treating drug-exposed newborns have existed for decades.
The Finnegan NAS scale was established in 1975|
