A Pregnant Woman's Battle with Fentanyl Addiction: How Keeping Her Baby Transformed Their Futures.

In her eighth month of pregnancy and suffering, the expectant mother arrived at the ER after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also dependent on fentanyl.

As medical staff managed her infection, she started to feel anxious. The onset of withdrawal began. She slumped forward and vomited.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had consumed opioids before coming to the ER and had only a brief window to get treated before she needed to go home to get high again. She thought she still had four weeks left to find a way to become sober and give birth.

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

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, her nurse, warned her: if she departed, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is often prescribed in rehabilitation.

A short time later, on the 12th of November, Stephanie had a baby girl weighing a small weight – premature, tiny yet healthy.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “no.” She was numb. Her pain relief did not work, her last dose of fentanyl had been provided four hours before delivery.

She felt unwell. Not ready for motherhood. Unworthy.

Stephanie had attempted sobriety multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.

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

The pervasive expectation that her love for her baby would make her stop using only led to deeper self-loathing and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was attached to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt nothing. “I looked at her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to name her baby Izzie, after the attendant who showed compassion to her.

Hospital staff told her about a specialized facility, a innovative treatment home where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when mothers and babies stay together, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she ultimately reached out. After verifying her eligibility for the program, two staff members came to pick her up.

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

At Maddie’s Place, Stephanie still was concerned that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any time, someone could enter and take her baby away.

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

Survival outdoors, she said, was about getting by. Drugs 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, much less anyone else.

Daily, staff from the facility drove her to a treatment center, given as medication. Gradually, she was beginning recovery.

She utilized each moment outside treatment with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had increased sensitivity and required an professional – all frequent conditions for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I found the strength. I would become a mother.

On a day prior to the holiday, Stephanie sat in the visitation area, where parents in active addiction can come for monitored interactions with their babies. An advocate, a peer support specialist, 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 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. Such issues were irrelevant.”

She has an image of the moment. She is dressed in casual attire, a gray knit hat with a decoration on her head, resting on the floor with the exit nearby. She is slender. Her face is downcast so you cannot see her face. She is holding Izzie up on her leg for the children to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the moms: “Where are all the dads?” The women attempted to clarify that the men were occupied, engaged elsewhere, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith looked at each other. “I became emotional,” 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 assessment tool was established in 1975|