She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Rescued Both Lives.

Pregnant and experiencing intense discomfort, the expectant mother arrived at the medical facility after her infection worsened up her legs. Without a job or home, estranged from her family, she resided in a small structure she had built in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. Withdrawal was setting in. She slumped forward and became sick.

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

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she had to return to get high again. She thought she still had four weeks left to plan her recovery and have this baby.

The medical professional intervened. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in substance abuse treatment.

After five days, on a day in November 2022, Stephanie had a daughter weighing a small weight – early, tiny yet healthy.

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

She felt unwell. Ill-equipped for parenting. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she relapsed. She felt without value, blaming herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her supplier declined to supply to her when she became clearly expecting.

“Yet I was unable,” she said. “I had to seek support.”

The common assumption that her affection for her child would make her recover 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 eliminate a long-term illness.

The baby was taken to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so little she thought she would break her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to name her baby after her caregiver, after the professional who provided support to her.

Medical personnel told her about Maddie’s Place, a new kind of care center where parents and infants affected by substance use are supported as a unit, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is proving a simple point: when families are kept intact, results get better, foster placements fall and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to collect her.

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

At the facility, Stephanie still was concerned that CPS 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 enter and take her baby away.

For the initial fortnight, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”

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

Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to let her down. She was unable to value herself, let alone anyone else.

Daily, staff from the center drove her to a clinic for methadone, provided orally. Over time, she was starting to get clean.

She spent every minute beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and severe digestive problems. She needed nutritional guidance. She also had increased sensitivity and required an professional – all typical problems for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I would become a mother.

One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a recovery coach, came over with her own family in tow to deliver baked goods. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in admiration of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a beanie with a decoration on her head, resting on the floor with the door behind her. She is lean. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the children to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the moms: “Why are there no men?” 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’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that newborns require care, then I could do this. I would become a mother.”

Methods to address drug-exposed newborns have been available for years.

The evaluation method was established in 1975|