A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Saved Them Both.

Eight months pregnant and in severe pain, the expectant mother went to the medical facility after her infection worsened up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had assembled in a friend’s yard. She was also hooked on fentanyl.

As doctors treated her infection, she started to feel anxious. The onset of withdrawal began. She leaned over the bed and vomited.

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

She had used fentanyl before coming to the ER and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the infection in her legs was critical, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, 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 every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be transitioned to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.

Five days later, on a day in November 2022, Stephanie had a infant weighing a small weight – premature, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her epidural had failed, her last dose of fentanyl had been provided a few hours prior to birth.

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

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt worthless, berating herself for not being able to achieve the unattainable. An obstetrician told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.

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

The common assumption that her love for her baby would make her quit only led to increased guilt and self-abuse, a impetus for her to use again. Yet she could not simply will her addiction away, any more than she could will away a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to tubes and leads, so little she thought she would break 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 still wasn’t sure she wanted to be her mother.

Following a brief period 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 women and their babies are supported as a unit, not apart.

In much of the US, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care and given drugs while their mothers face parental assessments. But a small, growing network of centers like Maddie’s Place is showing an important truth: when mothers and babies stay together, recovery succeeds, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to collect her.

She left the medical center still in detox, scared and uncertain about what would happen next.

At the facility, Stephanie still feared that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The fear lingered: that at any time, someone could arrive and take her baby away.

For the initial fortnight, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about survival. Drugs came first; trust came last.

Stephanie had one close friend, but even that relationship was delicate. The individuals she cared for always found ways to hurt her. She did not know how to love herself, let alone anyone else.

Daily, staff from the facility took her to a recovery program, given as medication. Slowly, she was starting to get clean.

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.

One afternoon before Thanksgiving, Stephanie was in the common room, where individuals struggling with substance use can come for monitored interactions with their babies. An advocate, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the little newborn 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 dressed in dark trousers and a sweatshirt, a beanie with a decoration on her head, seated on the ground with the exit nearby. She is slender. Her face is downcast so you do not see her expression. She is holding Izzie up on her leg for the young ones to see and they are standing close, fawning and reaching out to the baby.

One child, eight, asked the moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.

“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I found the courage. I could be a mom.”

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

The evaluation method was developed in 1975|