A Pregnant Woman's Battle with Fentanyl Addiction: Choosing Motherhood Rescued Both Lives.

In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the hospital emergency room after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she lived in a shed she had assembled in a companion's property. She was also addicted to fentanyl.

As medical staff managed her infection, she began to panic. Symptoms of withdrawal emerged. She slumped forward and vomited.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had taken the drug 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 find a way to become sober and give birth.

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

“I will go,” Stephanie said.

But the doctors would not let her go: the infection in her legs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, Izzie, warned her: if she walked out, she and her baby would be at risk of death.

Izzie persuaded the doctor to give Stephanie regulated amounts of fentanyl periodically, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

A short time later, on 12 November 2022, Stephanie delivered a infant weighing just over four pounds – born before term, tiny yet healthy.

When the caregiver questioned if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was emotionless. Her pain relief did not work, her previous intake of fentanyl had been provided a few hours prior to birth.

She felt sick. Not ready for motherhood. Not fit.

Stephanie had tried to get clean multiple times while expecting, and felt awful each time she was unsuccessful. She felt hopeless, blaming herself for not being able to achieve the unattainable. An obstetrician told her to “simply” stop using. Even her supplier refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her bond with her newborn would make her quit only led to increased guilt and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could will away a long-term illness.

The infant was moved to the NICU. When Stephanie finally saw her her, she was connected to monitors, so tiny she thought she would harm her. Holding her for the first time, she felt detached. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to call her daughter Izzie, after the nurse who had been so kind to her.

Hospital staff told her about a care center, a innovative treatment home where parents and infants affected by substance use are treated together, not apart.

In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a small, growing network of centers like the care home is showing an important truth: when mothers and babies stay together, recovery succeeds, custody cases decrease and future expenses reduce.

It took Stephanie a period to find strength to call, but she ultimately reached out. After confirming she would be a good fit for the program, two staff members came to pick her up.

She left the medical center still in recovery, scared and uncertain about what would follow.

At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any point, someone could enter 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 was suspicious at that point.”

Homelessness, she said, was about survival. Drugs came first; reliance came last.

Stephanie had one close friend, but even that connection was tenuous. The individuals she cared for always found ways to let her down. She was unable to value herself, let alone anyone else.

Every day, staff from Maddie’s Place transported her to a recovery program, provided orally. Gradually, 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 girl had some trouble feeding at first, with sensitivity to certain foods and obvious stomach troubles. She needed feeding therapy. She also had increased sensitivity and required an occupational therapist – all common issues 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 sat in the visitation area, where those still using can come for supervised visits with their babies. A support specialist, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was seated on the ground holding Izzie.

The young ones stared in admiration of the small baby in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They overlooked my addiction. None of those things mattered to them.”

She has an image of the moment. She is dressed in black pants and a hoodie, a gray knit hat with a bobble on her head, seated on the ground with the entryway at her back. She is thin. Her head is tilted forward so you miss her features. She is presenting her daughter on her leg for the other kids to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The parents responded that the fathers had obligations, called away to other tasks, that they would be there if possible.

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

Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I could be a mom.”

Tools for treating drug-exposed newborns have been available for years.

The Finnegan NAS scale was developed in 1975|