She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Saved Them Both.
In her eighth month of pregnancy and suffering, a woman named Stephanie went to the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had constructed in a friend’s yard. She was also hooked on fentanyl.
As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and vomited.
Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”
She had taken the drug before seeking medical help and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to find a way to become sober and have this baby.
The attending nurse disagreed. She told Stephanie she was not allowed to leave.
“I am leaving,” Stephanie said.
But the medical facility declined to release her: the leg infection was severe, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.
The nurse convinced the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm 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 substance abuse treatment.
A short time later, on 12 November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – born before term, little but surviving.
When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been administered a few hours prior to birth.
She felt unwell. Not ready for motherhood. Not fit.
Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she failed. She felt hopeless, berating herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her source would not provide to her when she became clearly expecting.
“However, I failed,” she said. “I required assistance.”
The common assumption that her love for her baby would make her quit only led to greater shame and self-harm, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a persistent condition.
The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was connected to medical equipment, so small she thought she would hurt her. Cradling her initially, she felt empty. “I looked at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.
After two days she decided to name her baby the same as her nurse, after the professional who provided support to her.
Hospital staff told her about a care center, 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 found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a small, growing network of centers like this facility is proving a simple point: when parents and infants remain united, outcomes improve, custody cases decrease and long-term costs decline.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to collect her.
She departed the institution still in detox, scared and uncertain about what would follow.
At the care center, Stephanie still was concerned that child services would come remove her daughter – even though she was hesitant about parenting. The concern persisted: that at any time, someone could enter and remove her child.
For the first two weeks, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I was suspicious at that point.”
Life on the streets, she said, was about getting by. Drugs came first; reliance came last.
Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to let her down. She lacked the ability to care for herself, much less anyone else.
Each day, staff from the center took her to a clinic for methadone, provided orally. Gradually, she was starting to get clean.
She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues 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 be a mom.
On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a recovery coach, 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 kids looked amazed in wonder 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 has an image of the moment. She is dressed in black pants and a hoodie, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her posture is humble so you do not see her expression. She is holding Izzie up on her lap for the young ones to see and they are standing close, showing interest to the baby.
One child, eight, asked the mothers: “What about the fathers?” The parents responded that the dads were busy, called away to other tasks, that they would be there if possible.
“Once I become a parent,” Jacob said, “I will excel as a father. I will teach them about love.”
Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could be a mom.”
Tools for treating babies with exposure have been used for a long time.
The assessment tool was developed in 1975|
