She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.

Eight months pregnant and in severe pain, the expectant mother arrived at the medical facility after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she resided in a small structure she had assembled in a companion's property. She was also dependent on fentanyl.

As doctors treated her infection, she grew increasingly fearful. Withdrawal was setting in. She bent over the bedside and became sick.

Stephanie ultimately gave in. “Listen, I gotta go. I have to go home and get high.”

She had consumed opioids before seeking medical help and had just enough time to get treated before she was compelled to leave to relapse. She thought she still had several weeks to figure out how to get clean and deliver her child.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she left, she and her baby would be at risk of death.

Izzie persuaded 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 drug that alleviates cravings and is commonly used in rehabilitation.

A short time later, on a day in November 2022, Stephanie had a baby girl weighing 4lb 8oz – early, little but surviving.

When the nurse asked if she wanted to hold her baby, Stephanie said “not now.” She was numb. Her anesthesia was ineffective, her last dose of fentanyl had been administered shortly before she gave birth.

She felt unwell. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt terrible each time she relapsed. She felt hopeless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her source refused to sell to her when she became visibly pregnant.

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

The common assumption that her bond with her newborn would make her quit only led to greater shame and self-abuse, a cause for her to use again. Yet she could not simply will her addiction away, any more than she could overcome a persistent condition.

The newborn was transferred to the neonatal intensive care unit. When Stephanie at last met her, she was hooked up to tubes and leads, so small she thought she would hurt her. Holding her for the first time, she felt nothing. “I just stared at her and was like, ‘What is our future?’” She remained uncertain she wanted to be her mother.

Following a brief period she decided to name her baby Izzie, after the attendant who showed compassion to her.

Nurses and doctors told her about a care center, a innovative treatment home where mothers and their drug-exposed newborns are cared for jointly, not apart.

In numerous states, where a baby is found to have neonatal abstinence syndrome (NAS) every 18 minutes, infants are still rushed to special care 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 parents and infants remain united, outcomes improve, fewer children enter care and long-term costs decline.

It took Stephanie a period to find strength to call, but she ultimately reached out. After verifying her eligibility for the program, care providers came to bring her to the facility.

She stepped out of the hospital still in recovery, fearful and unsure about what would happen next.

At the facility, Stephanie still worried that child services would come seize her child – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could walk in and remove her child.

For the initial fortnight, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

Homelessness, she said, was about survival. Addiction came first; reliance 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 love herself, much less anyone else.

Every day, staff from Maddie’s Place transported her to a clinic for methadone, administered in pill form. Over time, she was beginning recovery.

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 pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an specialist – all typical problems for babies born with NAS.

If this little kid could see that these babies deserve to be loved, then I found the strength. I could be a mom.

On a day prior to the holiday, Stephanie remained in the shared space, where individuals struggling with substance use can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, came over with her own family in tow to drop off cookies. They all assembled beside Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. Such issues were irrelevant.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a cap with a decoration on her head, sitting on the wooden floor with the entryway at her back. She is lean. Her head is tilted forward so you do not see her expression. She is holding Izzie up on her knee for the young ones to see and they are standing close, showing interest to the baby.

A young boy, eight, asked the moms: “What about the fathers?” The moms tried to explain that the dads were busy, handling responsibilities, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. I will teach them about love.”

Stephanie and her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I would become a mother.”

Approaches for managing drug-exposed newborns have existed for decades.

The Finnegan NAS scale was created in 1975|