She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.
Pregnant and experiencing intense discomfort, the expectant mother went to the ER after an infection began spreading up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had assembled 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 threw up.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”
She had consumed opioids before seeking medical help and had sufficient opportunity 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 have this baby.
The nurse had other ideas. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the leg infection was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in addiction recovery.
Five days later, on a day in November 2022, Stephanie gave birth to a infant weighing 4lb 8oz – premature, small but alive.
When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been provided shortly before she gave birth.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer refused to sell to her when she became obviously with child.
“But I couldn’t,” she said. “I needed help.”
The widespread belief that her love for her baby would make her recover only led to greater shame and self-harm, a trigger for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a long-term illness.
The infant was moved to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to monitors, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.
Following a brief period she decided to name her baby the same as her nurse, after the professional who provided support to her.
Medical personnel told her about a specialized facility, a innovative treatment home where women and their babies are treated together, not apart.
In many parts of America, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a limited but expanding group of centers like the care home is showing an important truth: when parents and infants remain united, outcomes improve, foster placements fall 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, care providers came to collect her.
She stepped out of the hospital still in detox, fearful and unsure about what would follow.
At Maddie’s Place, Stephanie still worried that child services would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could enter and remove her child.
For the beginning period, 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. Substances came first; faith came last.
Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She lacked the ability to value herself, much less anyone else.
Each day, staff from the facility drove her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.
She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an professional – all frequent conditions 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.
One afternoon before Thanksgiving, Stephanie remained in the shared space, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, visited with her own five kids in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.
The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is clad in black pants and a hoodie, a gray knit hat with a decoration on her head, seated on the ground with the exit nearby. She is lean. Her posture is humble so you do not see her expression. She is presenting her daughter on her lap for the children to see and they are gathered around, fawning and reaching out to the baby.
A young boy, eight, asked the moms: “Why are there no men?” The parents responded that the dads were busy, called away to other tasks, that they would be there if possible.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”
Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could be a mom.”
Methods to address infants affected by substances have been available for years.
The assessment tool was developed in 1975|
