A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Transformed Their Futures.

Eight months pregnant and in severe pain, the expectant mother arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had assembled in a acquaintance's garden. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.

Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she needed to go home to use once more. She thought she still had four weeks left to plan her recovery and deliver her child.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the leg infection was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie gave birth to a baby girl weighing a small weight – premature, small but alive.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been provided a few hours prior to birth.

She felt unwell. Unprepared to be a mother. Undeserving.

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

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

The pervasive expectation that her affection for her child would make her recover only led to increased guilt and self-harm, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to medical equipment, so little she thought she would break her. Cradling her initially, she felt empty. “I looked at 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 give her child the name Izzie, after the professional who provided support to her.

Hospital staff told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are cared for jointly, not apart.

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like this facility is showing an important truth: when families are kept intact, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she finally did. After ensuring she qualified for the program, a couple of employees came to collect her.

She left the medical center still in recovery, scared and uncertain about what would come next.

At Maddie’s Place, Stephanie still worried that authorities would come take Izzie – even though she was uncertain about motherhood. The concern persisted: that at any point, someone could arrive and take her baby away.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I was suspicious at that point.”

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

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

Daily, staff from Maddie’s Place transported her to a clinic for methadone, provided orally. Gradually, she was starting to get clean.

She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an specialist – all typical problems for babies born with NAS.

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

During a pre-holiday visit, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground 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 dressed in casual attire, a cap with a bobble on her head, resting on the floor with the exit nearby. She is thin. Her posture is humble so you cannot see her face. She is presenting her daughter on her knee for the young ones to see and they are crowding near, fawning and reaching out to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

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 could do this. I could be a mom.”

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

The Finnegan NAS scale was developed in 1975|