A Pregnant Woman's Battle with Fentanyl Addiction: How Keeping Her Baby Transformed Their Futures.

In her eighth month of pregnancy and suffering, the expectant mother visited the ER after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she stayed in a makeshift shelter she had built in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and threw up.

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

She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she needed to go home to get high again. 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 will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten 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 rehabilitation.

A short time later, on 12 November 2022, Stephanie delivered a infant weighing a small weight – born before term, tiny yet healthy.

When the attendant inquired if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided shortly before she gave birth.

She felt ill. Ill-equipped for parenting. Unworthy.

Stephanie had sought recovery multiple times while expecting, and felt awful each time she failed. She felt hopeless, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

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

The widespread belief that her bond with her newborn would make her quit only led to increased guilt and self-harm, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to monitors, so small she thought she would break her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to call her daughter after her caregiver, after the professional who provided support to her.

Nurses and doctors told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is identified with newborn addiction symptoms regularly, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when parents and infants remain united, results get better, 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 confirming she would be a good fit for the program, care providers came to bring her to the facility.

She left the medical center still in withdrawal, fearful and unsure about what would happen next.

At the facility, Stephanie still feared that child services would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any point, someone could arrive and separate them.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Survival outdoors, she said, was about getting by. Addiction came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to cause pain. She was unable to care for herself, let alone anyone else.

Daily, staff from the facility transported her to a recovery program, administered in pill form. Gradually, she was beginning recovery.

She spent every minute when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all typical problems 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.

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, visited with her own family in tow to bring treats. They all gathered around 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 showed no judgment,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a cap with a decoration on her head, resting on the floor with the exit nearby. She is slender. Her head is tilted forward so you miss her features. She is presenting her daughter on her leg for the young ones to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the mothers: “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 given the chance.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could be a mom.”

Methods to address infants affected by substances have been available for years.

The Finnegan NAS scale was created in 1975|