She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Transformed Their Futures.

Eight months pregnant and in severe pain, a woman named Stephanie went to the medical facility after a serious infection started to spread up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had constructed in a companion's property. She was also addicted to fentanyl.

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

Stephanie finally broke down. “Listen, I gotta go. I have to go home and get high.”

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she had to return to use once more. She thought she still had several weeks to plan her recovery and give birth.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was serious, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a treatment that reduces symptoms and is often prescribed in rehabilitation.

A short time later, on a day in November 2022, Stephanie had a infant weighing a small weight – born before term, small but alive.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been given four hours before delivery.

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

Stephanie had sought recovery repeatedly before birth, and felt awful each time she failed. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her dealer declined to supply to her when she became obviously with child.

“However, I failed,” she said. “I needed help.”

The widespread belief that her affection for her child would make her quit only led to increased guilt and self-abuse, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the special care nursery. When Stephanie eventually visited her, she was connected to tubes and leads, so small she thought she would harm her. Embracing her at last, she felt nothing. “I just stared 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 call her daughter Izzie, after the professional who provided support to her.

Hospital staff told her about a specialized facility, a new kind of care center where parents and infants affected by substance use are treated together, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and medicated while their mothers face custody evaluations. But a limited but expanding group of centers like Maddie’s Place is showing an important truth: when families are kept intact, results get better, fewer children enter care and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After ensuring she qualified for the program, a couple of employees came to pick her up.

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

At the care center, Stephanie still was concerned that child services 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 enter and take her baby away.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”

Life on the streets, she said, was about survival. Addiction came first; faith came last.

Stephanie had a single companion, but even that relationship was delicate. The those close to her always found ways to hurt her. She was unable to care for herself, much less anyone else.

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

She devoted all her time beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed feeding therapy. She also had sensory challenges and required an occupational therapist – all frequent conditions for babies exposed to substances.

When a child recognizes these infants need affection, then I was capable. I could parent.

During a pre-holiday visit, Stephanie was in the common room, where individuals struggling with substance use 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 assembled beside Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in awe of the little newborn in Stephanie’s arms. “They were innocent,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat with a decoration on her head, sitting on the wooden floor with the exit nearby. She is slender. Her face is downcast so you miss her features. She is holding Izzie up on her lap for the young ones to see and they are crowding near, showing interest to the baby.

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

“When I have kids,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and Bunch-Smith exchanged glances. “I became emotional,” Stephanie said. “When a child recognized that newborns require care, then I found the courage. I could parent.”

Tools for treating babies with exposure have existed for decades.

The assessment tool was established in 1975|