Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.

Pregnant and experiencing intense discomfort, the expectant mother visited the ER after an infection began spreading up her legs. Without a job or home, separated from loved ones, she lived in a shed she had built in a companion's property. She was also dependent on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She slumped forward and vomited.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had used fentanyl before seeking medical help and had just enough time to get treated before she was compelled to leave to relapse. 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 going anywhere.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

Five days later, on a day in November 2022, Stephanie had a daughter weighing a small weight – early, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was emotionless. Her anesthesia was ineffective, her last dose of fentanyl had been given four hours before delivery.

She felt ill. Unprepared to be a mother. Not fit.

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she was unsuccessful. She felt worthless, criticizing 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 visibly pregnant.

“However, I failed,” she said. “I required assistance.”

The pervasive expectation that her affection for her child would make her recover only led to greater shame and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would break 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.

Two days later she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where women and their babies are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to pick her up.

She stepped out of the hospital still in detox, fearful and unsure about what would come next.

At the care center, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any point, someone could arrive and separate them.

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about getting by. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She was unable to love herself, not to mention anyone else.

Each day, staff from the center took her to a treatment center, provided orally. Over time, she was beginning recovery.

She devoted all her time 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 obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies born with NAS.

When a child recognizes these infants need affection, then I found the strength. I could parent.

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, seated on the ground with the exit nearby. She is slender. Her head is tilted forward so you cannot see her face. She is holding Izzie up on her knee for the young ones to see and they are crowding near, showing interest to the baby.

One child, eight, asked the parents: “Why are there no men?” The parents responded that the dads were busy, handling responsibilities, that they would be there if they could.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I could parent.”

Methods to address drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was created in 1975|