Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Transformed Their Futures.

Eight months pregnant and in severe pain, a woman named Stephanie arrived at the ER 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 companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and threw up.

Stephanie finally broke down. “I need to leave. I have to go home and take a hit.”

She had taken the drug before coming to the ER and had just enough time to get treated before she had to return to get high again. She thought she still had four weeks left to figure out how to get clean and have this baby.

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 leg infection was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, 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 switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

A short time later, on the 12th of November, Stephanie delivered a baby girl weighing 4lb 8oz – born before term, small but alive.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “no.” She was emotionless. Her pain relief did not work, her final administration of fentanyl had been provided four hours before delivery.

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had sought recovery multiple times while expecting, and felt horrible each time she failed. She felt without value, berating herself for not being able to overcome the challenge. An OBGYN told her to “only” stop using. Even her source refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her love for her baby would make her recover only led to greater shame and self-harm, a cause for her to return to drugs. Yet she could not easily command her addiction away, any more than she could will away a long-term illness.

The newborn was transferred to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to monitors, so little she thought she would break her. Cradling her initially, 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 after her caregiver, after the nurse who had been so kind to her.

Nurses and doctors told her about Maddie’s Place, a innovative treatment home where parents and infants affected by substance use are supported as a unit, not apart.

In numerous states, where a baby is identified with newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, a couple of employees came to bring her to the facility.

She stepped out of the hospital still in withdrawal, scared and uncertain about what would come next.

At the care center, Stephanie still was concerned that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could enter and remove her child.

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

Survival outdoors, she said, was about getting by. Drugs came first; faith came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to hurt her. She was unable to love herself, not to mention anyone else.

Daily, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Slowly, she was embracing sobriety.

She devoted all her time when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges 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 could parent.

On a day prior to the holiday, Stephanie sat in the visitation area, where those still using can come for guided meetings with their babies. A support specialist, a peer support specialist, visited with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The kids looked amazed in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. They focused only on the baby.”

She has an image of the moment. She is wearing casual attire, a gray knit hat with a pompom on her head, seated on the ground with the exit nearby. She is lean. Her head is tilted forward so you cannot see her face. She is lifting the baby on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “Why are there no men?” The women attempted to clarify that the dads were busy, called away to other tasks, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could parent.”

Methods to address drug-exposed newborns have been available for years.

The evaluation method was created in 1975|