Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
In her eighth month of pregnancy and suffering, the expectant mother visited the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, separated from loved ones, she resided in a small structure she had constructed in a acquaintance's garden. She was also dependent on fentanyl.
As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and became sick.
Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”
She had consumed opioids before coming to the ER and had just enough time to get treated before she had to return to use once more. She thought she still had four weeks left to figure out how to get clean and give birth.
The medical professional intervened. She told Stephanie she was staying put.
“I am leaving,” Stephanie said.
But the doctors would not let her go: the condition in her limbs was serious, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.
She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.
After five days, on the 12th of November, Stephanie delivered a baby girl weighing a small weight – born before term, small but alive.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been given four hours before delivery.
She felt unwell. Ill-equipped for parenting. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt awful each time she relapsed. She felt without value, berating herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her dealer declined to supply to her when she became visibly pregnant.
“But I couldn’t,” she said. “I had to seek support.”
The common assumption that her bond with her newborn would make her stop using only led to greater shame and self-abuse, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was connected to medical equipment, so small she thought she would harm her. Embracing her at last, she felt empty. “I just stared at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.
Following a brief period she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.
Nurses and doctors told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In many parts of America, where a baby is identified with infant withdrawal condition regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when mothers and babies stay together, outcomes improve, custody cases decrease and overall savings increase.
It took Stephanie a period to find strength to call, but she eventually made the call. 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 recovery, scared and uncertain about what would follow.
At the care center, 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 point, someone could walk in and separate them.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Homelessness, she said, was about survival. Addiction came first; trust came last.
Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She was unable to value herself, not to mention anyone else.
Every day, staff from the facility drove her to a treatment center, provided orally. Slowly, she was embracing sobriety.
She devoted all her time outside treatment 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 severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.
When a child recognizes these infants need affection, then I was capable. I would become a mother.
One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. An advocate, a mentor, visited with her own five kids in tow to bring treats. They all crowded near Stephanie, who was sitting on the floor holding Izzie.
The young ones stared 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 keeps a photo of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a decoration on her head, resting on the floor with the exit nearby. She is slender. Her face is downcast so you cannot see her face. She is lifting the baby on her knee for the other kids to see and they are crowding near, showing interest to the baby.
One child, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the dads were busy, engaged elsewhere, that they would be there if they could.
“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I would become a mother.”
Approaches for managing drug-exposed newborns have been available for years.
The Finnegan NAS scale was established in 1975|
