Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.

In her eighth month of pregnancy and suffering, a woman named Stephanie went to the hospital emergency room after an infection began spreading up her legs. Without a job or home, estranged from her family, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and vomited.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had a month remaining to figure out how to get clean and give birth.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but physicians found she also had an ruptured membrane. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie delivered a daughter weighing just over four pounds – born before term, tiny yet healthy.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been provided four hours before delivery.

She felt sick. Unprepared to be a mother. Undeserving.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her source refused to sell to her when she became visibly pregnant.

“Yet I was unable,” she said. “I required assistance.”

The widespread belief that her bond with her newborn would make her quit only led to deeper self-loathing and self-abuse, a trigger for her to relapse. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the NICU. When Stephanie finally saw her her, she was attached to medical equipment, so tiny she thought she would hurt her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart.

In much of the US, where a baby is found to have infant withdrawal condition regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face custody evaluations. But a small, growing network of centers like this facility is demonstrating a key fact: when families are kept intact, outcomes improve, custody cases decrease and overall savings increase.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to bring her to the facility.

She departed the institution still in detox, anxious and doubtful about what would follow.

At Maddie’s Place, Stephanie still feared that child services would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and take her baby away.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about getting by. Substances 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 lacked the ability to love herself, not to mention anyone else.

Each day, staff from Maddie’s Place transported her to a recovery program, given as medication. Gradually, she was embracing sobriety.

She spent every minute beyond therapy 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 obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an professional – all frequent conditions for babies exposed to substances.

When a child recognizes these infants need affection, then I found the strength. I could be a mom.

On a day prior to the holiday, Stephanie sat in the visitation area, where individuals struggling with substance use can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, came over with her own five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

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 entryway at her back. She is lean. Her posture is humble so you do not see her expression. She is lifting the baby on her knee for the young ones to see and they are standing close, admiring and touching to the baby.

One child, eight, asked the mothers: “Where are all the dads?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I could do this. I would become a mother.”

Approaches for managing drug-exposed newborns have been used for a long time.

The Finnegan NAS scale was established in 1975|