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

In her eighth month of pregnancy and suffering, the expectant mother arrived at the hospital emergency room after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she lived in a shed she had built in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had consumed opioids before seeking medical help and had sufficient opportunity 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 nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the leg infection was critical, but physicians found she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

Five days later, on 12 November 2022, Stephanie had a baby girl weighing a small weight – early, tiny yet healthy.

When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was numb. Her epidural had failed, her final administration of fentanyl had been provided a few hours prior to birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she relapsed. She felt without value, criticizing herself for not being able to do the impossible. An obstetrician told her to “simply” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

“But I couldn’t,” she said. “I needed help.”

The pervasive expectation that her love for her baby would make her stop using only led to greater shame and negative self-talk, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to monitors, so tiny she thought she would break her. Cradling her initially, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Two days later she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition 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 this facility is showing an important truth: when families are kept intact, outcomes improve, custody cases decrease and future expenses reduce.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to pick her up.

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

At the facility, Stephanie still was concerned that child services would come take Izzie – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could enter and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “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.”

Homelessness, she said, was about enduring. Drugs came first; reliance came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She lacked the ability to care for herself, much less anyone else.

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

She spent every minute when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an specialist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I could do this. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for supervised visits with their babies. An advocate, a recovery coach, visited with her own five kids in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She keeps a photo of the moment. She is wearing dark trousers and a sweatshirt, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her posture is humble so you cannot see her face. She is holding Izzie up on her leg for the children to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the dads were busy, engaged elsewhere, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could be a mom.”

Approaches for managing babies with exposure have been used for a long time.

The assessment tool was created in 1975|