She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Transformed Their Futures.

Pregnant and experiencing intense discomfort, a woman named Stephanie visited the hospital emergency room after an infection began spreading up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had assembled in a companion's property. She was also addicted to fentanyl.

As doctors treated her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had several weeks to find a way to become sober and deliver her child.

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

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities 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 drug that alleviates cravings and is frequently utilized in addiction recovery.

After five days, on the 12th of November, Stephanie gave birth to a baby girl weighing a small weight – premature, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “not now.” She was detached. Her epidural had failed, her final administration of fentanyl had been administered a few hours prior to birth.

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

Stephanie had attempted sobriety multiple times while expecting, and felt horrible each time she was unsuccessful. She felt worthless, criticizing herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her dealer refused to sell to her when she became obviously with child.

“Yet I was unable,” she said. “I needed help.”

The pervasive expectation that her bond with her newborn would make her recover only led to increased guilt and self-harm, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was attached to monitors, so tiny she thought she would hurt her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘How will I care for you?’” She remained uncertain 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.

Medical personnel told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns 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 rushed to special care and given drugs while their mothers face custody evaluations. But a small, growing network of centers like the care home is proving a simple point: when parents and infants remain united, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to bring her to the facility.

She stepped out of the hospital still in detox, scared and uncertain about what would follow.

At Maddie’s Place, Stephanie still was concerned that CPS would come remove her daughter – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could arrive and remove her child.

For the first two weeks, 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. Substances came first; faith came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to hurt her. She lacked the ability to care for herself, let alone anyone else.

Each day, staff from Maddie’s Place drove her to a treatment center, given as medication. Over time, she was embracing sobriety.

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 intolerance to some formulas and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I found the strength. I could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. An advocate, a peer support specialist, visited with her own children in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She keeps a photo of the moment. She is wearing casual attire, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is thin. Her head is tilted forward so you miss her features. She is presenting her daughter on her leg for the children to see and they are crowding near, admiring and touching to the baby.

A young boy, eight, asked the parents: “Where are all the dads?” The parents responded that the men were occupied, handling responsibilities, that they would be there if they could.

“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could parent.”

Tools for treating infants affected by substances have been used for a long time.

The assessment tool was developed in 1975|