Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.
Eight months pregnant and in severe pain, the expectant mother went to the ER after her infection worsened up her legs. Without a job or home, estranged from her family, she resided in a small structure she had assembled in a companion's property. She was also hooked on fentanyl.
As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and vomited.
Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”
She had taken the drug before coming to the ER and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had several weeks to figure out how to get clean and give birth.
The attending nurse disagreed. She told Stephanie she was not going anywhere.
“Yes, I am,” Stephanie said.
But the hospital refused to discharge her: the leg infection was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.
Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl periodically, 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 frequently utilized in substance abuse treatment.
After five days, on the 12th of November, Stephanie gave birth to a baby girl weighing just over four pounds – born before term, little but surviving.
When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was detached. Her pain relief did not work, her final administration of fentanyl had been given a few hours prior to birth.
She felt sick. Ill-equipped for parenting. Unworthy.
Stephanie had sought recovery repeatedly before birth, and felt horrible each time she failed. She felt without value, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her supplier refused to sell to her when she became visibly pregnant.
“Yet I was unable,” she said. “I required assistance.”
The pervasive expectation that her affection for her child would make her quit only led to greater shame and self-abuse, a trigger for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.
The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to tubes and leads, so little she thought she would break her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.
After two days she decided to name her baby after her caregiver, after the professional who provided support to her.
Medical personnel told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.
In many parts of America, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a small, growing network of centers like the care home is showing an important truth: when parents and infants remain united, recovery succeeds, custody cases decrease and overall savings increase.
It took Stephanie a while to gather the courage to call, but she ultimately reached out. After confirming she would be a good fit for the program, care providers came to bring her to the facility.
She stepped out of the hospital still in detox, fearful and unsure about what would follow.
At the care center, Stephanie still worried that CPS would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and take her baby away.
For the first two weeks, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”
Survival outdoors, she said, was about getting by. Addiction came first; trust came last.
Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to cause pain. She was unable to care for herself, much less anyone else.
Each day, staff from the facility drove her to a treatment center, provided orally. Gradually, she was beginning recovery.
She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS.
Seeing that even a young person understands the need for care, then I found the strength. I could parent.
On a day prior to the holiday, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. A support specialist, a mentor, visited with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.
The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. Such issues were irrelevant.”
She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is slender. Her head is tilted forward so you miss her features. She is lifting the baby on her lap 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 fathers had obligations, 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 looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could be a mom.”
Approaches for managing babies with exposure have been used for a long time.
The Finnegan NAS scale was created in 1975|
