A Pregnant Woman's Battle with Fentanyl Addiction: Choosing Motherhood Transformed Their Futures.

Pregnant and experiencing intense discomfort, a woman named Stephanie visited the medical facility after her infection worsened up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had constructed in a friend’s yard. She was also dependent on fentanyl.

As physicians addressed her infection, she began to panic. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie ultimately gave in. “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 just enough time to get treated before she was compelled to leave to use once more. She thought she still had several weeks to figure out how to get clean and have this baby.

The nurse had other ideas. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but medical staff detected she also had an ruptured membrane. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

Five days later, on 12 November 2022, Stephanie delivered a baby girl weighing just over four pounds – premature, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.

She felt unwell. Unprepared to be a mother. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An obstetrician told her to “just” stop using. Even her supplier refused to sell to her when she became clearly expecting.

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

The common assumption that her affection for her child would make her stop using only led to greater shame and self-harm, a impetus for her to use again. Yet she could not just wish her addiction away, any more than she could overcome a long-term illness.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was hooked up to medical equipment, so little she thought she would harm her. Cradling her initially, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Following a brief period 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 Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie a period to find strength to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to collect her.

She left the medical center still in detox, anxious and doubtful about what would come next.

At Maddie’s Place, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any point, someone could enter and remove her child.

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

Homelessness, she said, was about enduring. Drugs came first; faith came last.

Stephanie had a trusted ally, but even that bond was fragile. The people she loved always found ways to let her down. She did not know how to love herself, much less anyone else.

Each day, staff from the facility transported her to a treatment center, given as medication. Slowly, she was beginning recovery.

She devoted all her time outside treatment with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had sensory challenges and required an professional – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. A support specialist, a mentor, came over 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 little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She has an image of the moment. She is dressed in casual attire, a beanie with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her head is tilted forward so you miss her features. She is lifting the baby on her knee for the young ones to see and they are standing close, admiring and touching to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the men were occupied, engaged elsewhere, that they would be there if they could.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and the specialist looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I would become a mother.”

Tools for treating drug-exposed newborns have existed for decades.

The Finnegan NAS scale was developed in 1975|