Fentanyl Addiction During Pregnancy: Choosing Motherhood Rescued Both Lives.

In her eighth month of pregnancy and suffering, the expectant mother went to the medical facility after a serious infection started to spread up her legs. Jobless and without shelter, estranged from her family, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and became sick.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had several weeks to plan her recovery and deliver her child.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery 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 gave birth to a daughter weighing 4lb 8oz – early, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been administered shortly before she gave birth.

She felt sick. Not ready for motherhood. Not fit.

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The common assumption that her affection for her child would make her recover only led to greater shame and negative self-talk, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was hooked up to tubes and leads, so little she thought she would harm her. Embracing her at last, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain she wanted to be her mother.

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

Nurses and doctors told her about a specialized facility, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is identified with newborn addiction symptoms frequently, 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 families are kept intact, results get better, foster placements fall and long-term costs decline.

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 collect her.

She stepped out of the hospital still in detox, scared and uncertain about what would follow.

At the facility, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could walk in and take her baby away.

For the first two weeks, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Homelessness, she said, was about survival. Drugs came first; trust came last.

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to let her down. She lacked the ability to care for herself, let alone anyone else.

Every day, staff from the facility transported her to a recovery program, provided orally. Slowly, she was beginning recovery.

She devoted all her time 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 sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an specialist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I would become a mother.

During a pre-holiday visit, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is wearing black pants and a hoodie, a beanie with a pompom on her head, seated on the ground with the entryway at her back. She is slender. Her face is downcast so you miss her features. She is lifting the baby on her leg for the young ones to see and they are gathered around, showing interest to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the fathers had obligations, 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 Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that newborns require care, then I could do this. I could be a mom.”

Approaches for managing babies with exposure have existed for decades.

The assessment tool was created in 1975|