She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Rescued Both Lives.

In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. The onset of withdrawal began. She bent over the bedside and became sick.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had taken the drug before coming to the ER and had only a brief window to get treated before she needed to go home to relapse. 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 not going anywhere.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the leg infection was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to 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 baby girl weighing 4lb 8oz – premature, little but surviving.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to do the impossible. An doctor told her to “just” stop using. Even her source would not provide to her when she became clearly expecting.

“But I couldn’t,” she said. “I had to seek support.”

The widespread belief that her love for her baby would make her quit only led to greater shame and negative self-talk, a trigger for her to relapse. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the NICU. When Stephanie finally saw her her, she was attached to monitors, so small she thought she would break her. Embracing her at last, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” 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 a care center, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In much of the US, where a baby is found to have infant withdrawal condition frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a limited but expanding group of centers like this facility is demonstrating a key fact: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, two staff members came to bring her to the facility.

She stepped out of the hospital still in detox, anxious and doubtful about what would come next.

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

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

Homelessness, she said, was about enduring. Substances came first; reliance came last.

Stephanie had one close friend, but even that relationship was delicate. The those close to her always found ways to hurt her. She did not know how to value herself, much less anyone else.

Every day, staff from the center transported her to a treatment center, 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 obtaining necessary support she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had increased sensitivity and required an professional – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for guided meetings with their babies. A support specialist, a recovery coach, stopped by with her own family in tow to drop off cookies. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, seated on the ground with the exit nearby. She is slender. Her posture is humble so you miss her features. She is presenting her daughter on her lap for the young ones to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the men were occupied, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could parent.”

Approaches for managing babies with exposure have existed for decades.

The evaluation method was created in 1975|