Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Rescued Both Lives.

Eight months pregnant and in severe pain, a woman named Stephanie visited the ER after her infection worsened up her legs. Unemployed and homeless, estranged from her family, she lived in a shed she had built in a acquaintance's garden. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She slumped forward and vomited.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before coming to the ER and had sufficient opportunity to get treated before she needed to go home to relapse. She thought she still had a month remaining to figure out how to get clean and give birth.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was serious, 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 be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

Five days later, on 12 November 2022, Stephanie gave birth to a baby girl weighing 4lb 8oz – born before term, small but alive.

When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been given a few hours prior to birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had sought recovery multiple times while expecting, and felt horrible each time she failed. She felt without value, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her source would not provide to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her recover only led to increased guilt and self-harm, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was hooked up to tubes and leads, so tiny she thought she would harm her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

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

Hospital staff told her about a specialized facility, a new kind of care center where women and their babies are supported as a unit, not apart.

In much of the US, where a baby is found to have infant withdrawal condition frequently, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like the care home is demonstrating a key fact: when mothers and babies stay together, outcomes improve, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to bring her to the facility.

She departed the institution still in recovery, scared and uncertain about what would come next.

At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could walk in and take her baby away.

For the first two weeks, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

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

Stephanie had one close friend, but even that bond was fragile. The people she loved always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else.

Daily, staff from the facility took her to a clinic for methadone, provided orally. Gradually, she was embracing sobriety.

She utilized each moment outside treatment 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 pronounced gastrointestinal issues. She needed feeding therapy. She also had sensory challenges and required an professional – all frequent conditions for babies exposed to substances.

When a child recognizes these infants need affection, 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 monitored interactions with their babies. A support specialist, a mentor, visited with her own children in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She holds a picture of the moment. She is dressed in black pants and a hoodie, a beanie with a decoration on her head, seated on the ground with the exit nearby. She is lean. Her face is downcast so you do not see her expression. She is presenting her daughter on her leg for the other kids to see and they are standing close, admiring and touching to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if they could.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I’m gonna show them that they deserve to be loved.”

Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I could do this. I could be a mom.”

Methods to address drug-exposed newborns have existed for decades.

The evaluation method was created in 1975|