She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
Pregnant and experiencing intense discomfort, a woman named Stephanie went to the ER after an infection began spreading up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also addicted to fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and vomited.
Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”
She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had a month remaining to plan her recovery and give birth.
The medical professional intervened. She told Stephanie she was not going anywhere.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was severe, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.
Five days later, on 12 November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – premature, little but surviving.
When the caregiver questioned if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been administered shortly before she gave birth.
She felt unwell. Ill-equipped for parenting. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt terrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “simply” stop using. Even her dealer declined to supply to her when she became clearly expecting.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her affection for her child would make her recover only led to deeper self-loathing and self-harm, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to monitors, so small she thought she would harm her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
After two days she decided to call her daughter the same as her nurse, after the professional who provided support to her.
Nurses and doctors told her about a care center, a innovative treatment home where women and their babies are cared for jointly, not apart.
In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a small, growing network of centers like this facility is showing an important truth: when parents and infants remain united, results get better, custody cases decrease and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to bring her to the facility.
She stepped out of the hospital still in recovery, anxious and doubtful about what would follow.
At the care center, Stephanie still was concerned that CPS would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any point, someone could enter and take her baby away.
For the beginning period, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Life on the streets, she said, was about getting by. Drugs came first; faith 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 lacked the ability to value herself, not to mention anyone else.
Every day, staff from the facility transported her to a treatment center, administered in pill form. Gradually, she was embracing sobriety.
She utilized each moment beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had increased sensitivity and required an occupational therapist – all frequent conditions for babies affected by withdrawal.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
On a day prior to the holiday, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. A support specialist, a recovery coach, stopped by with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in awe of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a pompom on her head, resting on the floor with the exit nearby. She is thin. Her face is downcast so you miss her features. She is presenting her daughter on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.
A young boy, eight, asked the parents: “Where are all the dads?” The parents responded that the dads were busy, engaged elsewhere, that they would be there given the chance.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could parent.”
Methods to address infants affected by substances have been available for years.
The assessment tool was developed in 1975|
