Fentanyl Addiction During Pregnancy: Choosing Motherhood Transformed Their Futures.

In her eighth month of pregnancy and suffering, the expectant mother arrived at the medical facility after an infection began spreading up her legs. Jobless and without shelter, estranged from her family, she resided in a small structure she had constructed in a friend’s yard. She was also dependent on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. The onset of withdrawal began. She bent over the bedside and threw up.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and take a hit.”

She had used fentanyl before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had a month remaining to plan her recovery and give birth.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was severe, but doctors had discovered she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would not survive.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be placed on methadone, a medication that eases withdrawal and is commonly used in addiction recovery.

After five days, on a day in November 2022, Stephanie delivered a infant weighing 4lb 8oz – premature, small but alive.

When the nurse asked if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her anesthesia was ineffective, her final administration of fentanyl had been administered shortly before she gave birth.

She felt sick. Unprepared to be a mother. Not fit.

Stephanie had attempted sobriety repeatedly before birth, and felt horrible each time she failed. She felt hopeless, criticizing herself for not being able to overcome the challenge. An obstetrician told her to “simply” stop using. Even her source refused to sell to her when she became visibly pregnant.

“But I couldn’t,” she said. “I needed help.”

The pervasive expectation that her affection for her child would make her quit only led to deeper self-loathing and self-abuse, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could overcome a chronic disease.

The infant was moved to the neonatal intensive care unit. When Stephanie at last met her, she was attached to tubes and leads, so small she thought she would break her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What am I going to do with you?’” She remained uncertain 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 Maddie’s Place, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is diagnosed with neonatal abstinence syndrome (NAS) regularly, infants are still whisked to NICUs and given drugs while their mothers face parental assessments. But a developing system of centers like the care home is demonstrating a key fact: when families are kept intact, outcomes improve, fewer children enter care and future expenses reduce.

It took Stephanie some time to build confidence to call, but she finally did. After ensuring she qualified for the program, care providers came to collect her.

She stepped out of the hospital still in withdrawal, anxious and doubtful about what would come next.

At the facility, Stephanie still worried that authorities would come seize her child – even though she was uncertain about motherhood. The anxiety remained: that at any time, someone could arrive and separate them.

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

Homelessness, she said, was about enduring. Substances came first; reliance came last.

Stephanie had a single companion, but even that bond was fragile. The those close to her always found ways to hurt her. She was unable to care for herself, let alone anyone else.

Daily, staff from the center took her to a clinic for methadone, administered in pill form. Slowly, she was beginning recovery.

She devoted all her time outside treatment 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 feeding therapy. She also had heightened sensory issues and required an occupational therapist – all frequent conditions for babies exposed to substances.

Seeing that even a young person understands the need for care, then I could do this. I would become a mother.

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a mentor, visited with her own family in tow to deliver baked goods. They all gathered around Stephanie, who was seated on the ground holding Izzie.

The children were wide-eyed in awe of the tiny infant in Stephanie’s arms. “They showed no judgment,” Stephanie said. “They didn’t care that I had used drugs with her. None of those things mattered to them.”

She holds a picture of the moment. She is dressed in dark trousers and a sweatshirt, a cap with a bobble on her head, resting on the floor with the entryway at her back. She is lean. Her face is downcast so you cannot see her face. She is lifting the baby 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 moms: “Where are all the dads?” The moms tried to explain that the fathers had obligations, handling responsibilities, that they would be there given the chance.

“Once I become a parent,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and her companion looked at each other. “I just lost it and fell apart,” Stephanie said. “When a child recognized that these babies deserve to be loved, then I was able. I could parent.”

Methods to address infants affected by substances have been used for a long time.

The evaluation method was established in 1975|