She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.
Eight months pregnant and in severe pain, the expectant mother visited the ER after her infection worsened up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had built in a acquaintance's garden. She was also addicted to fentanyl.
As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.
Stephanie finally broke down. “Listen, I gotta go. I have to go home and use drugs.”
She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to get high again. She thought she still had several weeks to find a way to become sober 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 critical, but doctors had discovered she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.
She encouraged the doctor to give Stephanie regulated amounts 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 rehabilitation.
A short time later, on a day in November 2022, Stephanie had a baby girl weighing a small weight – born before term, little but surviving.
When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.
She felt sick. Not ready for motherhood. Not fit.
Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt without value, blaming herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer would not provide to her when she became clearly expecting.
“Yet I was unable,” she said. “I needed help.”
The pervasive expectation that her love for her baby would make her quit only led to greater shame and self-abuse, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a persistent condition.
The infant was moved to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to tubes and leads, so little she thought she would break her. Cradling her initially, she felt empty. “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.
Two days later she decided to name her baby Izzie, after the nurse who had been so kind to her.
Medical personnel told her about a specialized facility, a unique recovery environment where women and their babies are cared for jointly, not apart.
In many parts of America, where a baby is found to have infant withdrawal condition frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, recovery succeeds, foster placements fall and future expenses reduce.
It took Stephanie a while to gather the courage to call, but she finally did. After verifying her eligibility for the program, care providers came to pick her up.
She stepped out of the hospital still in recovery, anxious and doubtful about what would come next.
At Maddie’s Place, Stephanie still worried that CPS would come seize her child – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could enter and separate them.
For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I lacked confidence at that point.”
Homelessness, she said, was about enduring. Substances came first; faith came last.
Stephanie had a trusted ally, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She did not know how to love herself, not to mention anyone else.
Each day, staff from the facility drove her to a recovery program, administered in pill form. 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 obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an professional – all typical problems for babies affected by withdrawal.
If this little kid could see that these babies deserve to be loved, then I found the strength. I could parent.
During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own five kids in tow to bring treats. They all crowded near Stephanie, who was seated on the ground holding Izzie.
The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”
She keeps a photo of the moment. She is wearing black pants and a hoodie, a cap with a bobble on her head, resting on the floor with the exit nearby. She is thin. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her leg for the other kids to see and they are crowding near, showing interest to the baby.
One child, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if possible.
“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”
Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could be a mom.”
Methods to address infants affected by substances have been used for a long time.
The assessment tool was developed in 1975|
