A Pregnant Woman's Battle with Fentanyl Addiction: Choosing Motherhood Saved Them Both.

In her eighth month of pregnancy and suffering, the expectant mother visited the ER after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She bent over the bedside and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she had to return to get high again. She thought she still had several weeks to plan her recovery and have this baby.

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

“I will go,” Stephanie said.

But the medical facility declined to release her: the leg infection was severe, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she walked out, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

Five days later, on the 12th of November, Stephanie had a baby girl weighing just over four pounds – premature, small but alive.

When the attendant inquired if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her anesthesia was ineffective, her previous intake of fentanyl had been administered four hours before delivery.

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

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she failed. She felt without value, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “just” stop using. Even her dealer refused to sell to her when she became obviously with child.

“However, I failed,” she said. “I required assistance.”

The widespread belief that her affection for her child would make her recover only led to increased guilt and negative self-talk, a cause for her to return to drugs. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie at last met her, she was attached to medical equipment, so little she thought she would harm her. Holding her for the first time, she felt detached. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to name her baby the same as her nurse, after the attendant who showed compassion to her.

Medical personnel told her about a specialized facility, a innovative treatment home where women and their babies are supported as a unit, not apart.

In much of the US, where a baby is diagnosed with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and given drugs while their mothers face parental assessments. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. After ensuring she qualified for the program, two staff members came to pick her up.

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

At the care center, Stephanie still worried that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could walk in and take her baby away.

For the beginning period, Stephanie stayed withdrawn. “I avoided interaction,” she said. “I lacked confidence at that point.”

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

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

Each day, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Over time, she was beginning recovery.

She utilized each moment when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions 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 individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, came over with her own children in tow to drop off cookies. They all crowded near Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in wonder of the tiny infant in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She keeps a photo of the moment. She is clad in black pants and a hoodie, a cap with a pompom on her head, seated on the ground with the entryway at her back. She is lean. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the other kids to see and they are crowding near, showing interest to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if they could.

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

Stephanie and Bunch-Smith exchanged glances. “I broke down,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I would become a mother.”

Approaches for managing infants affected by substances have been available for years.

The evaluation method was developed in 1975|