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 ER after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As doctors treated her infection, she grew increasingly fearful. The onset of withdrawal began. She slumped forward and threw up.

Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to use once more. She thought she still had several weeks to find a way to become sober and deliver her child.

The nurse had other ideas. She told Stephanie she was not going anywhere.

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was critical, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in substance abuse treatment.

A short time later, on 12 November 2022, Stephanie delivered a daughter weighing a small weight – premature, small but alive.

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

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

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she relapsed. She felt without value, criticizing herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her supplier refused to sell to her when she became obviously with child.

“Yet I was unable,” she said. “I required assistance.”

The widespread belief that her love for her baby would make her recover only led to increased guilt and self-harm, a trigger for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was attached to tubes and leads, so little she thought she would hurt her. Cradling her initially, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to give her child the name 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 parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a developing system of centers like this facility is demonstrating a key fact: when families are kept intact, results get better, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to pick her up.

She departed the institution still in recovery, fearful and unsure about what would follow.

At the facility, Stephanie still feared that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any moment, someone could arrive and remove her child.

For the beginning period, 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.”

Survival outdoors, she said, was about survival. Drugs came first; faith came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to cause pain. She lacked the ability to love herself, let alone anyone else.

Every day, staff from Maddie’s Place took her to a treatment center, provided orally. Slowly, she was starting to get clean.

She utilized each moment beyond therapy with Izzie, and could see that her baby was receiving appropriate attention 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 professional – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I found the strength. I could parent.

One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. An advocate, a peer support specialist, visited with her own family in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed 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 casual attire, a cap with a pompom on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you do not see her expression. She is lifting the baby on her knee for the children to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the fathers had obligations, called away to other tasks, that they would be there if they could.

“In the future,” 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 just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I could parent.”

Approaches for managing infants affected by substances have been available for years.

The assessment tool was established in 1975|