She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.
Eight months pregnant and in severe pain, a woman named Stephanie went to the medical facility after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a companion's property. She was also addicted to fentanyl.
As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and vomited.
Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”
She had taken the drug before coming to the ER and had only a brief window to get treated before she needed to go home to get high again. She thought she still had four weeks left to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was severe, but physicians found she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is frequently utilized in addiction recovery.
After five days, on a day in November 2022, Stephanie delivered a daughter weighing just over four pounds – early, small but alive.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been provided shortly before she gave birth.
She felt sick. Not ready for motherhood. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she relapsed. She felt without value, blaming herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her source refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I had to seek support.”
The pervasive expectation that her affection for her child would make her recover only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.
The infant was moved to the NICU. When Stephanie at last met her, she was hooked up to tubes and leads, so little she thought she would hurt her. Holding her for the first time, she felt detached. “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.
Two days later she decided to name her baby after her caregiver, after the nurse who had been so kind to her.
Hospital staff told her about a care center, a innovative treatment home where women and their babies are cared for jointly, not apart.
In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and medicated while their mothers face parental assessments. But a small, growing network of centers like this facility is showing an important truth: when mothers and babies stay together, recovery succeeds, custody cases decrease and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, care providers came to pick her up.
She left the medical center still in detox, anxious and doubtful about what would come next.
At the facility, Stephanie still feared that child services would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could enter and separate them.
For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about survival. Addiction came first; reliance came last.
Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to let her down. She did not know how to love herself, much less anyone else.
Daily, staff from the facility transported her to a recovery program, administered in pill form. Slowly, she was embracing sobriety.
She devoted all her time when not in sessions 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 feeding therapy. She also had sensory challenges and required an specialist – all common issues for babies exposed to substances.
When a child recognizes these infants need affection, then I could do this. I could be a mom.
During a pre-holiday visit, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. An advocate, a peer support specialist, visited 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 kids looked amazed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”
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 entryway at her back. She is thin. Her posture is humble so you miss her features. She is holding Izzie up on her knee for the young ones to see and they are standing close, admiring and touching to the baby.
Jacob, eight, asked the mothers: “Where are all the dads?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if they could.
“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.”
Tools for treating babies with exposure have existed for decades.
The Finnegan NAS scale was developed in 1975|
