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 went to the medical facility after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had assembled in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. Withdrawal was setting in. She bent over the bedside and threw up.

Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”

She had consumed opioids before coming to the ER and had just enough time to get treated before she had to return to get high again. She thought she still had several weeks to find a way to become sober and give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

After five days, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – premature, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered shortly before she gave birth.

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

Stephanie had attempted sobriety repeatedly before birth, and felt awful each time she failed. She felt without value, blaming 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 clearly expecting.

“However, I failed,” she said. “I had to seek support.”

The common assumption that her bond with her newborn would make her quit only led to greater shame and self-harm, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the NICU. When Stephanie finally saw her her, she was connected to monitors, so little she thought she would break her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

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

Hospital staff told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are cared for jointly, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to collect her.

She departed the institution still in recovery, anxious and doubtful about what would happen next.

At Maddie’s Place, Stephanie still worried that authorities would come seize her child – even though she was hesitant about parenting. The concern persisted: that at any moment, someone could enter and take her baby away.

For the beginning period, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about getting by. Drugs came first; reliance came last.

Stephanie had a trusted ally, but even that connection was tenuous. The those close to her always found ways to hurt her. She lacked the ability to care for herself, much less anyone else.

Every day, staff from Maddie’s Place took her to a recovery program, given as medication. Gradually, she was starting to get clean.

She utilized each moment outside treatment 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 pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an specialist – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I could do this. I could parent.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a mentor, stopped by with her own family in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is clad in casual attire, a cap with a decoration on her head, sitting on the wooden floor with the door behind her. She is slender. Her face is downcast so you cannot see her face. 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 mothers: “Why are there no men?” The moms tried to explain that the men were occupied, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I was able. I could be a mom.”

Methods to address babies with exposure have existed for decades.

The assessment tool was created in 1975|