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

Eight months pregnant and in severe pain, the expectant mother went to the ER after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also dependent on fentanyl.

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

Stephanie ultimately gave in. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before seeking medical help and had only a brief window to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and give birth.

The medical professional intervened. She told Stephanie she was not going anywhere.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was critical, but medical staff detected she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

A short time later, on 12 November 2022, Stephanie delivered a daughter weighing 4lb 8oz – early, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her last dose of fentanyl had been given a few hours prior to birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt terrible each time she relapsed. She felt hopeless, 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.

“However, I failed,” she said. “I required assistance.”

The widespread belief that her affection for her child would make her stop using only led to increased guilt and negative self-talk, a impetus for her to return to drugs. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The infant was moved to the NICU. When Stephanie eventually visited her, she was connected to monitors, so small she thought she would hurt her. Embracing her at last, she felt empty. “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 name her baby after her caregiver, after the attendant who showed compassion to her.

Hospital staff told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is diagnosed with infant withdrawal condition frequently, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a small, growing network of centers like the care home is proving a simple point: when parents and infants remain united, recovery succeeds, custody cases decrease and future expenses reduce.

It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to pick her up.

She departed the institution still in detox, scared and uncertain about what would come next.

At Maddie’s Place, Stephanie still feared that CPS would come take Izzie – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could walk in and take her baby away.

For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about enduring. Drugs came first; faith 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, not to mention anyone else.

Each day, staff from Maddie’s Place drove her to a recovery program, provided orally. Over time, she was embracing sobriety.

She devoted all her time outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods 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.

Seeing that even a young person understands the need for care, then I could do this. I could be a mom.

One afternoon before Thanksgiving, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. A support specialist, a peer support specialist, visited with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She has an image of the moment. She is dressed in black pants and a hoodie, a cap with a bobble on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you miss her features. She is presenting her daughter on her lap for the young ones to see and they are gathered around, showing interest to the baby.

One child, eight, asked the parents: “Why are there no men?” The parents responded that the dads were busy, engaged elsewhere, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion looked at each other. “I broke down,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could parent.”

Approaches for managing drug-exposed newborns have existed for decades.

The assessment tool was created in 1975|