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 arrived at the medical facility after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had constructed in a friend’s yard. She was also addicted to fentanyl.
As medical staff managed her infection, she began to panic. Withdrawal was setting in. She slumped forward and threw up.
Stephanie ultimately gave in. “I need to leave. 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 use once more. She thought she still had several weeks to find a way to become sober and deliver her child.
The nurse had other ideas. She told Stephanie she was staying put.
“I will go,” Stephanie said.
But the medical facility declined to release her: the infection in her legs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.
A short time later, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – born before term, little but surviving.
When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been given shortly before she gave birth.
She felt ill. Not ready for motherhood. Not fit.
Stephanie had sought recovery multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, blaming herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her supplier would not provide to her when she became visibly pregnant.
“But I couldn’t,” she said. “I needed help.”
The widespread belief that her love for her baby would make her quit only led to greater shame and self-abuse, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.
The newborn was transferred to the special care nursery. When Stephanie at last met her, she was connected to medical equipment, so little she thought she would harm her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What is our future?’” 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 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 identified with infant withdrawal condition regularly, infants are still quickly moved to hospitals and given drugs while their mothers face custody evaluations. But a developing system of centers like the care home is proving a simple point: when mothers and babies stay together, recovery succeeds, fewer children enter care and overall savings increase.
It took Stephanie some time to build confidence 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 departed the institution still in withdrawal, scared and uncertain about what would come next.
At Maddie’s Place, Stephanie still worried that authorities would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could arrive and take her baby away.
For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” 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 trusted ally, but even that connection was tenuous. The those close to her always found ways to cause pain. She was unable to love herself, not to mention anyone else.
Daily, staff from the facility drove her to a clinic for methadone, given as medication. Over time, she was starting to get clean.
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 sensitivity to certain foods and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an professional – all typical problems for babies exposed to substances.
If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.
During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own children in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a cap with a pompom on her head, seated on the ground with the door behind her. She is slender. Her face is downcast so you do not see her expression. She is holding Izzie up on her lap for the children to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “Where are all the dads?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if possible.
“When I have kids,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”
Stephanie and the specialist looked at each other. “I became emotional,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I could do this. I could parent.”
Approaches for managing babies with exposure have been available for years.
The evaluation method was created in 1975|
