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

Eight months pregnant and in severe pain, a woman named Stephanie went to the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she resided in a small structure she had assembled in a friend’s yard. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She bent over the bedside and vomited.

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

She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had a month remaining to plan her recovery and give birth.

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 infection in her legs was critical, 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 face grave danger.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in rehabilitation.

After five days, on 12 November 2022, Stephanie had a baby girl weighing 4lb 8oz – early, little but surviving.

When the attendant inquired if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was detached. Her epidural had failed, her last dose of fentanyl had been administered a few hours prior to birth.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had sought recovery repeatedly before birth, and felt terrible each time she relapsed. She felt hopeless, berating herself for not being able to do the impossible. An doctor told her to “simply” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

“However, I failed,” she said. “I had to seek support.”

The widespread belief that her bond with her newborn would make her stop using only led to increased guilt and self-harm, a impetus for her to relapse. Yet she could not easily command her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the NICU. When Stephanie eventually visited her, she was attached to monitors, so little she thought she would hurt her. Embracing her at last, she felt detached. “I just stared at her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

Two days later she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.

Medical personnel told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is showing an important truth: when families are kept intact, results get better, foster placements fall and overall savings increase.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After verifying her eligibility for the program, care providers came to collect her.

She departed the institution still in detox, anxious and doubtful about what would follow.

At the facility, Stephanie still worried that authorities would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any point, someone could arrive and take her baby away.

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

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

Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She was unable to care for herself, let alone anyone else.

Each day, staff from Maddie’s Place took her to a recovery program, administered in pill form. Slowly, she was embracing sobriety.

She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support 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 specialist – all frequent conditions for babies exposed to substances.

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

One afternoon before Thanksgiving, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. An advocate, a peer support specialist, stopped by with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The kids looked amazed in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a cap with a pompom on her head, resting on the floor with the exit nearby. She is thin. Her face is downcast so you miss her features. She is lifting the baby on her lap for the children to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the parents: “Why are there no men?” The moms tried to explain that the dads were busy, called away to other tasks, that they would be there if they could.

“Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could be a mom.”

Approaches for managing drug-exposed newborns have been available for years.

The evaluation method was established in 1975|