Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.

In her eighth month of pregnancy and suffering, the expectant mother visited the ER after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital 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 find a way to become sober and give birth.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the leg infection 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 be at risk of death.

She encouraged the doctor to give Stephanie controlled doses 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 drug that alleviates cravings and is often prescribed in substance abuse treatment.

Five days later, on the 12th of November, Stephanie gave birth to a infant weighing just over four pounds – born before term, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been given a few hours prior to birth.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she failed. She felt worthless, berating herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her source declined to supply to her when she became obviously with child.

“Yet I was unable,” she said. “I had to seek support.”

The pervasive expectation that her affection for her child would make her recover only led to increased guilt and self-harm, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the NICU. When Stephanie finally saw her her, she was connected to tubes and leads, so small she thought she would harm her. Cradling her initially, she felt detached. “I looked at her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

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

Nurses and doctors told her about a specialized facility, a new kind of care center where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is found to have infant withdrawal condition every 18 minutes, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a developing system of centers like the care home is demonstrating a key fact: when families are kept intact, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to pick her up.

She stepped out of the hospital still in detox, anxious and doubtful about what would come next.

At the care center, Stephanie still worried that authorities would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and take her baby away.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”

Homelessness, she said, was about enduring. Drugs came first; reliance came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She was unable to love herself, not to mention anyone else.

Every day, staff from Maddie’s Place transported her to a clinic for methadone, administered in pill form. Gradually, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a mentor, visited with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet 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. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in casual attire, a gray knit hat with a pompom on her head, sitting on the wooden floor with the exit nearby. She is thin. Her posture is humble so you do not see her expression. She is presenting her daughter on her knee for the other kids to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the moms: “Why are there no men?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if they could.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I would become a mother.”

Approaches for managing infants affected by substances have been used for a long time.

The Finnegan NAS scale was established in 1975|