Fentanyl Addiction During Pregnancy: How Keeping Her Baby Rescued Both Lives.

Pregnant and experiencing intense discomfort, the expectant mother visited the hospital emergency room after her infection worsened up her legs. Jobless and without shelter, estranged from her family, she lived in a shed she had built in a friend’s yard. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and threw up.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had several weeks to figure out how to get clean and have this baby.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

Five days later, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – premature, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her pain relief did not work, her last dose of fentanyl had been given four hours before delivery.

She felt ill. Not ready for motherhood. Not fit.

Stephanie had sought recovery several times during pregnancy, and felt terrible each time she relapsed. She felt without value, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her dealer declined to supply to her when she became obviously with child.

“Yet I was unable,” 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 trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.

The infant was moved to the NICU. When Stephanie at last met her, she was attached to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to give her child the name Izzie, after the professional who provided support to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, custody cases decrease and overall savings increase.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to bring her to the facility.

She stepped out of the hospital still in recovery, scared and uncertain about what would happen next.

At Maddie’s Place, Stephanie still was concerned that CPS would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any time, someone could arrive and take her baby away.

For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about enduring. Substances came first; reliance came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to hurt her. She lacked the ability to value herself, much less anyone else.

Daily, staff from the center transported her to a treatment center, 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 getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in admiration of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is wearing casual attire, a beanie with a bobble on her head, sitting on the wooden floor with the exit nearby. She is thin. Her face is downcast so you miss her features. She is lifting the baby on her leg for the other kids to see and they are crowding near, showing interest to the baby.

One child, eight, asked the moms: “Where are all the dads?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there if possible.

“When I have kids,” Jacob said, “I plan to be a great parent. I will teach them about love.”

Stephanie and Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that newborns require care, then I found the courage. I could parent.”

Tools for treating drug-exposed newborns have been available for years.

The Finnegan NAS scale was developed in 1975|