Fentanyl Addiction During Pregnancy: The Decision to Keep Her Child Saved Them Both.

Eight months pregnant and in severe pain, the expectant mother arrived at the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, estranged from her family, she resided in a small structure she had built in a companion's property. She was also dependent on fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and became sick.

Stephanie finally broke down. “I have to get out of here. I have to go home and use drugs.”

She had used fentanyl before arriving at the hospital and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had several weeks to plan her recovery and deliver her child.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would not survive.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a drug that alleviates cravings and is often prescribed in addiction recovery.

A short time later, on 12 November 2022, Stephanie delivered a infant weighing just over four pounds – premature, little but surviving.

When the nurse asked if she wanted to embrace her child, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been administered four hours before delivery.

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

Stephanie had sought recovery multiple times while expecting, and felt awful each time she relapsed. She felt hopeless, berating herself for not being able to achieve the unattainable. An doctor told her to “simply” stop using. Even her supplier declined to supply to her when she became clearly expecting.

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

The widespread belief that her love for her baby would make her stop using only led to deeper self-loathing and negative self-talk, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was attached to medical equipment, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I just stared at her and was like, ‘What am I going to do with you?’” She continued to doubt she wanted to be her mother.

Two days later she decided to call her daughter the same as her nurse, after the attendant who showed compassion to her.

Hospital staff told her about Maddie’s Place, a unique recovery environment where parents and infants affected by substance use are cared for jointly, not apart.

In many parts of America, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when mothers and babies stay together, results get better, custody cases decrease and overall savings increase.

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

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

At the facility, Stephanie still feared that authorities 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 enter and remove her child.

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

Homelessness, she said, was about survival. Substances came first; faith came last.

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to hurt her. She was unable to value herself, much less anyone else.

Daily, staff from the facility drove her to a recovery program, given as medication. Slowly, she was embracing sobriety.

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 obvious stomach troubles. She needed dietary support. She also had sensory challenges and required an professional – all frequent conditions for babies born with NAS.

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

On a day prior to the holiday, Stephanie was in the common room, where parents in active addiction can come for monitored interactions with their babies. Katie Bunch-Smith, a peer support specialist, stopped by with her own children in tow to deliver baked goods. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in wonder of the little newborn 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 keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a pompom on her head, resting on the floor with the exit nearby. She is thin. Her head is tilted forward so you miss her features. She is presenting her daughter on her leg for the young ones to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the parents: “Where are all the dads?” The parents responded that the men were occupied, handling responsibilities, that they would be there if possible.

“When I have kids,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith made eye contact. “I became emotional,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”

Approaches for managing babies with exposure have existed for decades.

The evaluation method was developed in 1975|