She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.

Eight months pregnant and in severe pain, a woman named Stephanie went to the hospital emergency room after a serious infection started to spread up her legs. Jobless and without shelter, separated from loved ones, she lived in a shed she had constructed in a friend’s yard. She was also hooked on fentanyl.

As physicians addressed her infection, she began to panic. Withdrawal was setting in. She leaned over the bed and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to get high again. She thought she still had four weeks left to plan her recovery 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 infection in her legs was critical, but physicians found 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.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.

After five days, on 12 November 2022, Stephanie gave birth to a baby girl weighing just over four pounds – early, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her epidural had failed, her previous intake of fentanyl had been administered four hours before delivery.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety several times during pregnancy, and felt horrible each time she failed. She felt worthless, blaming herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her source declined to supply to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her quit only led to deeper self-loathing and self-abuse, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was connected to tubes and leads, so little she thought she would hurt her. Cradling her initially, she felt detached. “I gazed upon 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 nurse who had been so kind to her.

Nurses and doctors told her about a care center, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is found to have infant withdrawal condition regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is proving a simple point: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to collect her.

She stepped out of the hospital still in recovery, fearful and unsure about what would come next.

At Maddie’s Place, Stephanie still was concerned that child services would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could walk in and separate them.

For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about enduring. Drugs came first; faith came last.

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else.

Every day, staff from the center transported her to a recovery program, administered in pill form. Slowly, she was starting to get clean.

She utilized each moment 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 obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all typical problems for babies affected by withdrawal.

When a child recognizes these infants need affection, then I could do this. I would become a mother.

One afternoon before Thanksgiving, Stephanie was in the common room, 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 bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She holds a picture of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a decoration on her head, seated on the ground with the door behind her. She is lean. Her posture is humble so you miss her features. She is lifting the baby on her lap for the children to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, 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. They will know they are valued.”

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could be a mom.”

Methods to address drug-exposed newborns have been used for a long time.

The evaluation method was established in 1975|