She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.

In her eighth month of pregnancy and suffering, the expectant mother visited the medical facility after her infection worsened up her legs. Jobless and without shelter, separated from loved ones, she stayed in a makeshift shelter she had assembled in a companion's property. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and vomited.

Stephanie eventually collapsed. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before coming to the ER and had just enough time to get treated before she needed to go home to relapse. 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 not allowed to leave.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, 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. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

After five days, on 12 November 2022, Stephanie had a infant weighing a small weight – born before term, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “not now.” She was detached. Her anesthesia was ineffective, her last dose of fentanyl had been provided four hours before delivery.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had tried to get clean repeatedly before birth, and felt awful each time she failed. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her supplier would not provide to her when she became clearly expecting.

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

The widespread belief that her bond with her newborn would make her stop using only led to deeper self-loathing and negative self-talk, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to medical equipment, so small she thought she would break her. Cradling her initially, 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.

After two days she decided to call her daughter the same as her nurse, after the nurse who had been so kind to her.

Hospital staff told her about Maddie’s Place, a innovative treatment home where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a developing system of centers like the care home is showing an important truth: when parents and infants remain united, recovery succeeds, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to pick her up.

She stepped out of the hospital still in recovery, fearful and unsure about what would happen next.

At the care center, Stephanie still feared that child services would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could arrive and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about enduring. Drugs came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to hurt her. She lacked the ability to love herself, let alone anyone else.

Each day, staff from Maddie’s Place transported her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.

She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had heightened sensory issues and required an professional – all frequent conditions for babies exposed to substances.

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

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. An advocate, a mentor, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is dressed in casual attire, a gray knit hat with a pompom on her head, seated on the ground with the door behind her. She is slender. Her face is downcast so you miss her features. She is lifting the baby on her knee for the children to see and they are gathered around, admiring and touching to the baby.

One child, 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 given the chance.

“Once I become a parent,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and her companion exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, 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|