A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Rescued Both Lives.

In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the ER after an infection began spreading up her legs. Jobless and without shelter, cut off from her relatives, she lived in a shed she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

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

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

She had taken the drug before coming to the ER and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to plan her recovery and give birth.

The medical professional intervened. She told Stephanie she was staying put.

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was severe, but medical staff detected she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be transitioned to methadone, a medication that eases withdrawal and is frequently utilized in addiction recovery.

After five days, on 12 November 2022, Stephanie delivered a daughter weighing a small weight – premature, small but alive.

When the caregiver questioned if she wanted to embrace her child, Stephanie said “I cannot.” She was detached. Her epidural had failed, her final administration of fentanyl had been administered shortly before she gave birth.

She felt sick. Not ready for motherhood. Unworthy.

Stephanie had sought recovery repeatedly before birth, and felt horrible each time she relapsed. She felt worthless, berating herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her dealer refused to sell to her when she became visibly pregnant.

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

The common assumption that her affection for her child would make her stop using only led to deeper self-loathing and negative self-talk, a cause for her to use again. Yet she could not easily command her addiction away, any more than she could will away a chronic disease.

The baby was taken to the neonatal intensive care unit. When Stephanie eventually visited her, she was hooked up to tubes and leads, so tiny she thought she would break her. Cradling her initially, she felt detached. “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.

After two days she decided to give her child the name after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is identified with neonatal abstinence syndrome (NAS) every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is proving a simple point: when mothers and babies stay together, results get better, custody cases decrease and long-term costs decline.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, two staff members came to pick her up.

She departed the institution still in withdrawal, anxious and doubtful about what would follow.

At the care center, Stephanie still worried that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could walk in and take her baby away.

For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” 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 a trusted ally, but even that connection was tenuous. The people she loved always found ways to let her down. She lacked the ability to care for herself, much less anyone else.

Every day, staff from the facility transported her to a recovery program, given as medication. Over time, she was beginning recovery.

She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had increased sensitivity and required an occupational therapist – all common issues for babies born with NAS.

Seeing that even a young person understands the need for care, then I was capable. I could parent.

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, stopped by with her own family in tow to deliver baked goods. They all crowded near Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in admiration of the tiny infant 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 dressed 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 lean. Her posture is humble so you cannot see her face. She is holding Izzie up on her leg for the other kids to see and they are gathered around, showing interest to the baby.

A young boy, eight, asked the mothers: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if they could.

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

Stephanie and her companion made eye contact. “I broke down,” Stephanie said. “If this little kid could see that infants need affection, then I found the courage. I would become a mother.”

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

The assessment tool was created in 1975|