Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.

Eight months pregnant and in severe pain, a woman named Stephanie visited the ER after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she began to panic. The onset of withdrawal began. She slumped forward and vomited.

Stephanie eventually collapsed. “I need to leave. I have to go home and take a hit.”

She had consumed opioids before coming to the ER and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had several weeks to find a way to become sober and give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.

She encouraged the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in rehabilitation.

Five days later, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – early, little but surviving.

When the attendant inquired if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her pain relief did not work, her final administration of fentanyl had been provided a few hours prior to birth.

She felt sick. Ill-equipped for parenting. Undeserving.

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, blaming herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her source would not provide to her when she became obviously with child.

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

The pervasive expectation that her love for her baby would make her stop using only led to increased guilt and self-harm, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.

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. Holding her for the first time, she felt detached. “I gazed upon 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 the same as her nurse, after the professional who provided support to her.

Medical personnel told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In numerous states, where a baby is identified with infant withdrawal condition frequently, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when parents and infants remain united, results get better, custody cases decrease and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to pick her up.

She departed the institution still in withdrawal, scared and uncertain about what would come next.

At the care center, Stephanie still feared that authorities would come take Izzie – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could enter and separate them.

For the beginning period, Stephanie kept to herself. “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 a single companion, but even that relationship was delicate. The those close to her always found ways to let her down. She did not know how to care for herself, much less anyone else.

Daily, staff from the facility transported her to a treatment center, administered in pill form. Slowly, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an specialist – all typical problems for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I could do this. I could parent.

On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for supervised visits with their babies. A support specialist, a recovery coach, visited with her own children in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She holds a picture of the moment. She is clad in casual attire, a beanie with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the young ones to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the moms: “What about the fathers?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there given the chance.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I was able. I could be a mom.”

Methods to address drug-exposed newborns have existed for decades.

The Finnegan NAS scale was created in 1975|