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

In her eighth month of pregnancy and suffering, a woman named Stephanie visited the ER after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she stayed in a makeshift shelter she had assembled in a companion's property. She was also addicted to fentanyl.

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

Stephanie eventually collapsed. “I need to leave. I have to go home and use drugs.”

She had used fentanyl before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had several weeks to plan her recovery and deliver her child.

The attending nurse disagreed. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

Five days later, on the 12th of November, Stephanie had a infant weighing just over four pounds – early, tiny yet healthy.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been given a few hours prior to birth.

She felt sick. Ill-equipped for parenting. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she relapsed. She felt worthless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “just” stop using. Even her dealer declined to supply to her when she became clearly expecting.

“However, I failed,” she said. “I needed help.”

The common assumption that her bond with her newborn would make her stop using only led to increased guilt and negative self-talk, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would hurt her. Cradling her initially, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to name her baby Izzie, after the professional who provided support to her.

Nurses and doctors told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In much of the US, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and medicated while their mothers face custody evaluations. But a developing system of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, results get better, custody cases decrease and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After ensuring she qualified for the program, care providers came to pick her up.

She departed the institution still in withdrawal, fearful and unsure about what would happen next.

At the care center, Stephanie still worried that child services would come take Izzie – even though she was hesitant about parenting. The anxiety remained: that at any time, someone could walk in and separate them.

For the beginning period, Stephanie kept to herself. “I preferred to be alone,” she said. “I was suspicious at that point.”

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

Stephanie had a single companion, but even that bond was fragile. The individuals she cared for always found ways to let her down. She was unable to love herself, not to mention anyone else.

Every day, staff from the facility transported her to a clinic for methadone, administered in pill form. Over time, she was embracing sobriety.

She spent every minute outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her infant faced feeding challenges at first, with adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all common issues for babies exposed to substances.

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

One afternoon before Thanksgiving, Stephanie was in the common room, where those still using can come for guided meetings with their babies. A support specialist, a recovery coach, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the entryway at her back. She is slender. Her posture is humble so you miss her features. She is presenting her daughter on her leg for the children to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the parents: “Where are all the dads?” The parents responded that the men were occupied, called away to other tasks, that they would be there given the chance.

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

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that newborns require care, then I found the courage. I could parent.”

Approaches for managing infants affected by substances have existed for decades.

The assessment tool was created in 1975|