She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both.

In her eighth month of pregnancy and suffering, a woman named Stephanie went to the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had constructed in a companion's property. She was also dependent on fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and became sick.

Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she was compelled to leave to relapse. She thought she still had four weeks left to figure out how to get clean and have this baby.

The medical professional intervened. She told Stephanie she was not going anywhere.

“Yes, I am,” 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, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl every few hours, 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 rehabilitation.

Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – premature, little but surviving.

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

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

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she was unsuccessful. She felt worthless, criticizing herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“However, I failed,” she said. “I needed help.”

The widespread belief that her love for her baby would make her stop using only led to greater shame and self-harm, a impetus for her to return to drugs. 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 eventually visited her, she was connected to tubes and leads, so small she thought she would harm her. Cradling her initially, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.

Nurses and doctors told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, results get better, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she finally did. 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, fearful and unsure about what would happen next.

At the care center, Stephanie still was concerned 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 remove her child.

For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”

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

Stephanie had a single companion, but even that connection was tenuous. The individuals she cared for always found ways to cause pain. She did not know how to love herself, not to mention anyone else.

Each day, staff from the center transported her to a recovery program, provided orally. Slowly, she was beginning recovery.

She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges 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 was in the common room, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She holds a picture of the moment. She is clad in casual attire, a cap with a pompom on her head, resting on the floor with the door behind her. She is thin. Her posture is humble so you miss her features. She is presenting her daughter on her knee for the children to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The parents responded that the fathers had obligations, handling responsibilities, that they would be there if possible.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I could do this. I would become a mother.”

Tools for treating babies with exposure have existed for decades.

The Finnegan NAS scale was developed in 1975|