Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.
Eight months pregnant and in severe pain, a woman named Stephanie visited the hospital emergency room after her infection worsened up her legs. Without a job or home, separated from loved ones, she lived in a shed she had assembled in a companion's property. She was also dependent on fentanyl.
As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and threw up.
Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”
She had used fentanyl before seeking medical help and had just enough time to get treated before she had to return to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.
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 infection in her legs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.
The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in substance abuse treatment.
A short time later, on the 12th of November, Stephanie gave birth to a infant weighing 4lb 8oz – born before term, little but surviving.
When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided shortly before she gave birth.
She felt sick. Unprepared to be a mother. Undeserving.
Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she relapsed. She felt hopeless, criticizing 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 obviously with child.
“Yet I was unable,” she said. “I required assistance.”
The common assumption that her love for her baby would make her stop using only led to greater shame and negative self-talk, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.
The newborn was transferred to the NICU. When Stephanie eventually visited her, she was hooked up to monitors, so little she thought she would harm her. Embracing her at last, she felt nothing. “I gazed upon her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.
Two days later she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.
Medical personnel told her about a care center, a new kind of care center where parents and infants affected by substance use are treated together, not apart.
In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, custody cases decrease and overall savings increase.
It took Stephanie a period to find strength to call, but she finally did. After ensuring she qualified for the program, two staff members came to bring her to the facility.
She left the medical center still in detox, scared and uncertain about what would come next.
At the care center, Stephanie still feared that child services would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could enter and separate them.
For the beginning period, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. Drugs came first; trust came last.
Stephanie had one close friend, but even that connection was tenuous. The people she loved always found ways to let her down. She did not know how to value herself, much less anyone else.
Each day, staff from Maddie’s Place drove her to a clinic for methadone, administered in pill form. Gradually, she was beginning recovery.
She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies exposed to substances.
Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.
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 peer support specialist, stopped by with her own children in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.
The kids looked amazed in admiration of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”
She has an image of the moment. She is clad in casual attire, a gray knit hat with a pompom on her head, resting on the floor with the entryway at her back. She is slender. Her face is downcast so you do not see her expression. She is lifting the baby on her leg for the children to see and they are crowding near, fawning and reaching out to the baby.
One child, eight, asked the parents: “Why are there no men?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there given the chance.
“In the future,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”
Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I could parent.”
Approaches for managing drug-exposed newborns have been used for a long time.
The Finnegan NAS scale was developed in 1975|