A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Saved Them Both.

In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and vomited.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had taken the drug before arriving at the hospital and had just enough time to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to find a way to become sober and deliver her child.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie had a infant weighing 4lb 8oz – born before term, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.

She felt ill. Unprepared to be a mother. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she relapsed. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became clearly expecting.

“Yet I was unable,” she said. “I needed help.”

The pervasive expectation that her love for her baby would make her stop using only led to increased guilt and self-abuse, 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 finally saw her her, she was attached to monitors, so little she thought she would hurt her. Cradling her initially, she felt nothing. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

Two days later she decided to call her daughter Izzie, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In numerous states, where a baby is found to have infant withdrawal condition frequently, infants are still quickly moved to hospitals and medicated while their mothers face parental assessments. But a developing system of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, a couple of employees came to collect her.

She left the medical center still in withdrawal, scared and uncertain about what would follow.

At the care center, Stephanie still worried that authorities would come take Izzie – even though she was hesitant about parenting. The concern persisted: that at any point, someone could enter and remove her child.

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

Survival outdoors, she said, was about getting by. Substances came first; trust came last.

Stephanie had a single companion, 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.

Every day, staff from Maddie’s Place took her to a recovery program, given as medication. Slowly, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an specialist – all typical problems for babies exposed to substances.

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

One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They were innocent,” 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 clad in black pants and a hoodie, a gray knit hat with a pompom on her head, sitting on the wooden floor with the exit nearby. She is slender. Her posture is humble so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are crowding near, showing interest to the baby.

A young boy, eight, asked the parents: “Where are all the dads?” The parents responded that the dads were busy, handling responsibilities, that they would be there given the chance.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and her companion exchanged glances. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I would become a mother.”

Approaches for managing infants affected by substances have existed for decades.

The assessment tool was created in 1975|