Fentanyl Addiction During Pregnancy: How Keeping Her Baby Rescued Both Lives.

In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also dependent on fentanyl.

As doctors treated her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and vomited.

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

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had a month remaining to find a way to become sober and have this baby.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the infection in her legs was critical, but physicians found she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing a small weight – early, little but surviving.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been administered a few hours prior to birth.

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

Stephanie had sought recovery multiple times while expecting, and felt horrible each time she was unsuccessful. She felt without value, criticizing herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her supplier would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I required assistance.”

The pervasive expectation that her love for her baby would make her recover only led to greater shame and self-abuse, a impetus for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a long-term illness.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would break her. Embracing her at last, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to call her daughter Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a new kind of care center where mothers and their drug-exposed newborns are supported as a unit, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when families are kept intact, outcomes improve, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to bring her to the facility.

She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.

At Maddie’s Place, Stephanie still worried that child services would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could walk in and take her baby away.

For the initial fortnight, Stephanie remained isolated. “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.”

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

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to let her down. She lacked the ability to love herself, not to mention anyone else.

Daily, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Over time, she was beginning recovery.

She spent every minute outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed nutritional guidance. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies exposed to substances.

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

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for guided meetings with their babies. An advocate, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is wearing black pants and a hoodie, a cap with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her face is downcast so you cannot see her face. She is lifting the baby on her leg for the other kids to see and they are crowding near, showing interest to the baby.

Jacob, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.

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

Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I would become a mother.”

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

The assessment tool was created in 1975|