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

Eight months pregnant and in severe pain, a woman named Stephanie arrived at the medical facility after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a companion's property. She was also dependent on fentanyl.

As doctors treated her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and get high.”

She had taken the drug before seeking medical help and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had four weeks left to find a way to become sober and deliver her child.

The attending nurse disagreed. 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 medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she walked out, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

A short time later, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – early, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her epidural had failed, her final administration of fentanyl had been administered four hours before delivery.

She felt ill. Not ready for motherhood. Not fit.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An OBGYN told her to “just” stop using. Even her dealer declined to supply to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her stop using 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 eliminate a chronic disease.

The infant was moved 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. Cradling her initially, she felt empty. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby Izzie, after the nurse who had been so kind to her.

Nurses and doctors told her about a care center, a unique recovery environment where women and their babies are cared for jointly, not apart.

In much of the US, where a baby is found to have infant withdrawal condition regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she eventually made the call. After verifying her eligibility for the program, a couple of employees came to collect her.

She left the medical center still in recovery, fearful and unsure about what would happen next.

At the care center, Stephanie still feared that authorities would come remove her daughter – even though she was uncertain about motherhood. The concern persisted: that at any moment, someone could arrive and separate them.

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

Homelessness, she said, was about survival. Addiction came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The those close to her always found ways to let her down. She lacked the ability to care for herself, much less anyone else.

Daily, staff from the center took her to a treatment center, provided orally. Slowly, she was embracing sobriety.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could parent.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. A support specialist, a recovery coach, came over with her own family in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She holds a picture of the moment. She is wearing casual attire, a beanie with a pompom on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her posture is humble so you do not see her expression. She is presenting her daughter on her leg for the young ones to see and they are gathered around, admiring and touching to the baby.

A young boy, eight, asked the parents: “What about the fathers?” The women attempted to clarify that the fathers had obligations, handling responsibilities, that they would be there if they could.

“In the future,” Jacob said, “I’m going to be the best dad ever. They will know they are valued.”

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I was able. I could be a mom.”

Methods to address infants affected by substances have existed for decades.

The assessment tool was established in 1975|