Fentanyl Addiction During Pregnancy: How Keeping Her Baby Transformed Their Futures.

Eight months pregnant and in severe pain, a woman named Stephanie went to the ER after her infection worsened up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had constructed in a acquaintance's garden. She was also hooked on fentanyl.

As physicians addressed her infection, she grew increasingly fearful. Symptoms of withdrawal emerged. She leaned over the bed and threw up.

Stephanie ultimately gave in. “I need to leave. I have to go home and get high.”

She had consumed opioids before seeking medical help and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to figure out how to get clean and give birth.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was critical, but doctors had discovered she also had an ruptured membrane. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in substance abuse treatment.

After five days, on the 12th of November, Stephanie gave birth to a daughter weighing just over four pounds – premature, small but alive.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her epidural had failed, her last dose of fentanyl had been administered shortly before she gave birth.

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

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, berating herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source declined to supply to her when she became clearly expecting.

“But I couldn’t,” she said. “I needed help.”

The pervasive expectation that her bond with her newborn would make her quit only led to greater shame and self-abuse, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a persistent condition.

The newborn was transferred to the special care nursery. When Stephanie eventually visited her, she was attached to tubes and leads, so tiny she thought she would hurt her. Cradling her initially, she felt empty. “I just stared at her and was like, ‘How will I care for you?’” She continued to doubt she wanted to be her mother.

Following a brief period she decided to give her child the name Izzie, after the professional who provided support to her.

Medical personnel told her about a care center, a unique recovery environment where mothers and their drug-exposed newborns are supported as a unit, not apart.

In much of the US, where a baby is found to have newborn addiction symptoms every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a small, growing network of centers like this facility is demonstrating a key fact: when parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she eventually made the call. 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 detox, anxious and doubtful about what would follow.

At the care center, Stephanie still feared that CPS would come remove her daughter – even though she was uncertain about motherhood. The fear lingered: that at any moment, someone could walk in and separate them.

For the first two weeks, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I didn’t have a lot of trust at that point.”

Life on the streets, she said, was about getting by. Substances came first; reliance came last.

Stephanie had one close friend, but even that bond was fragile. The those close to her always found ways to cause pain. She lacked the ability to love herself, much less anyone else.

Every day, staff from Maddie’s Place drove her to a treatment center, given as medication. Over time, she was embracing sobriety.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an professional – all common issues for babies born with NAS.

When a child recognizes these infants need affection, then I could do this. I could parent.

One afternoon before Thanksgiving, Stephanie sat in the visitation area, where parents in active addiction can come for supervised visits with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to deliver baked goods. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She holds a picture of the moment. She is wearing black pants and a hoodie, a gray knit hat with a decoration on her head, sitting on the wooden floor with the exit nearby. She is lean. Her face is downcast so you do not see her expression. She is presenting her daughter on her knee for the young ones to see and they are gathered around, fawning and reaching out to the baby.

Jacob, eight, asked the moms: “What about the fathers?” The parents responded that the men were occupied, engaged elsewhere, that they would be there given the chance.

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

Stephanie and the specialist exchanged glances. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I could do this. I would become a mother.”

Tools for treating infants affected by substances have been available for years.

The assessment tool was created in 1975|