She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.

Pregnant and experiencing intense discomfort, a woman named Stephanie visited the medical facility after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had constructed in a friend’s yard. She was also addicted to fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She leaned over the bed and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had four weeks left to plan her recovery and give birth.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was serious, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would not survive.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a treatment that reduces symptoms and is often prescribed in substance abuse treatment.

Five days later, on a day in November 2022, Stephanie had a daughter weighing a small weight – early, small but alive.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been given a few hours prior to birth.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean several times during pregnancy, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her supplier would not provide to her when she became visibly pregnant.

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

The pervasive expectation that her love for her baby would make her recover only led to greater shame and negative self-talk, a impetus for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie at last met her, she was connected to monitors, so small she thought she would break her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to name her baby the same as her nurse, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, foster placements fall and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After ensuring she qualified for the program, care providers came to collect her.

She left the medical center still in recovery, fearful and unsure about what would follow.

At the facility, Stephanie still was concerned that authorities would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any time, someone could arrive and separate them.

For the first two weeks, Stephanie kept to herself. “I avoided interaction,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about getting by. Addiction came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She did not know how to care for herself, not to mention anyone else.

Each day, staff from Maddie’s Place drove her to a treatment center, administered in pill form. Over time, she was embracing sobriety.

She utilized each moment beyond therapy 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 severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an professional – all typical problems for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. An advocate, a recovery coach, visited with her own family in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in admiration of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a bobble on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast so you cannot see her face. She is presenting her daughter on her knee for the children to see and they are standing close, showing interest to the baby.

One child, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there if possible.

“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I could parent.”

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

The Finnegan NAS scale was developed in 1975|