She Was Pregnant and Addicted to Fentanyl: How Keeping Her Baby Transformed Their Futures.

In her eighth month of pregnancy and suffering, a woman named Stephanie visited the ER after her infection worsened up her legs. Unemployed and homeless, cut off from her relatives, she resided in a small structure she had assembled in a friend’s yard. She was also dependent on fentanyl.

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

Stephanie ultimately gave in. “I need to leave. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she needed to go home to get high again. She thought she still had four weeks left to figure out how to get clean and have this baby.

The medical professional intervened. She told Stephanie she was not allowed to leave.

“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, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie controlled doses of fentanyl every few hours, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be switched to methadone, a medication that eases withdrawal and is often prescribed in addiction recovery.

After five days, on the 12th of November, Stephanie had a baby girl weighing 4lb 8oz – premature, tiny yet healthy.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been administered a few hours prior to birth.

She felt unwell. Ill-equipped for parenting. Not fit.

Stephanie had tried to get clean several times during pregnancy, and felt terrible each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An doctor told her to “simply” stop using. Even her dealer declined to supply to her when she became visibly pregnant.

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

The pervasive expectation that her love for her baby would make her stop using only led to deeper self-loathing and self-harm, a cause for her to relapse. Yet she could not just wish her addiction away, any more than she could will away a long-term illness.

The baby was taken to the NICU. When Stephanie at last met her, she was attached to medical equipment, so tiny she thought she would break her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Two days later she decided to give her child the name after her caregiver, after the attendant who showed compassion to her.

Medical personnel told her about a specialized facility, a new kind of care center 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 newborn addiction symptoms regularly, infants are still rushed to special care and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like Maddie’s Place is proving a simple point: when families are kept intact, results get better, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she ultimately reached out. 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 withdrawal, fearful and unsure about what would follow.

At the care center, Stephanie still was concerned that child services would come take Izzie – even though she was uncertain about motherhood. The anxiety remained: that at any moment, someone could arrive and remove her child.

For the initial fortnight, Stephanie stayed withdrawn. “I didn’t really want anything to do with any of them,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about enduring. Substances came first; faith came last.

Stephanie had a trusted ally, but even that bond was fragile. The individuals she cared for always found ways to hurt her. She did not know how to care for herself, much less anyone else.

Each day, staff from the center drove her to a recovery program, administered in pill form. Over time, she was embracing sobriety.

She devoted all her time when not in sessions with Izzie, and could see that her baby was getting the specialized care she needed. Her daughter struggled with eating at first, with intolerance to some formulas and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all common issues for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I was capable. I would become a mother.

On a day prior to the holiday, 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 five kids in tow to drop off cookies. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She keeps a photo of the moment. She is clad in dark trousers and a sweatshirt, a cap with a pompom on her head, sitting on the wooden floor with the exit nearby. She is lean. Her head is tilted forward so you miss her features. She is holding Izzie up on her knee for the other kids to see and they are standing close, admiring and touching to the baby.

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

“Once I become a parent,” Jacob said, “I plan to be a great parent. I’m gonna show them that they deserve to be loved.”

Stephanie and Bunch-Smith made eye contact. “I broke down,” Stephanie said. “If this little kid could see that these babies deserve to be loved, then I was able. I could be a mom.”

Tools for treating infants affected by substances have been used for a long time.

The assessment tool was created in 1975|