She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.
In her eighth month of pregnancy and suffering, the expectant mother visited the ER after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.
As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and threw up.
Stephanie eventually collapsed. “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 use once more. She thought she still had several weeks to find a way to become sober 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 condition in her limbs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.
She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.
After five days, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – premature, tiny yet healthy.
When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided four hours before delivery.
She felt unwell. Unprepared to be a mother. Not fit.
Stephanie had sought recovery repeatedly before birth, and felt terrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her source declined to supply to her when she became visibly pregnant.
“However, I failed,” she said. “I required assistance.”
The common assumption that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The infant was moved to the NICU. When Stephanie finally saw her her, she was connected to medical equipment, so tiny she thought she would hurt her. Holding her for the first time, she felt empty. “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 give her child the name after her caregiver, after the attendant who showed compassion to her.
Hospital staff told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.
In much of the US, where a baby is found to have newborn addiction symptoms frequently, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a small, growing network of centers like the care home is proving a simple point: when parents and infants remain united, recovery succeeds, foster placements fall and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to pick her up.
She departed the institution still in withdrawal, anxious and doubtful about what would come next.
At the facility, Stephanie still was concerned that CPS would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any time, someone could enter and take her baby away.
For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about survival. Drugs came first; trust came last.
Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to cause pain. She was unable to love herself, much less anyone else.
Every day, staff from Maddie’s Place drove her to a recovery program, given as medication. Over time, she was beginning recovery.
She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an professional – all common issues for babies born with NAS.
When a child recognizes these infants need affection, then I found the strength. I would become a mother.
During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. An advocate, a recovery coach, came over with her own children in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a gray knit hat with a bobble on her head, resting on the floor with the door behind her. She is slender. Her posture is humble so you cannot see her face. She is presenting her daughter on her leg for the other kids to see and they are standing close, fawning and reaching out to the baby.
A young boy, eight, asked the mothers: “Why are there no men?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if they could.
“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I would become a mother.”
Tools for treating drug-exposed newborns have been available for years.
The assessment tool was created in 1975|