Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.

In her eighth month of pregnancy and suffering, the expectant mother visited the ER after a serious infection started to spread up her legs. Unemployed and homeless, separated from loved ones, she stayed in a makeshift shelter she had constructed in a companion's property. She was also hooked on fentanyl.

As physicians addressed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She slumped forward and became sick.

Stephanie eventually collapsed. “Listen, I gotta go. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she was compelled to leave to relapse. She thought she still had several weeks to find a way to become sober and give birth.

The nurse had other ideas. She told Stephanie she was staying put.

“I will go,” Stephanie said.

But the doctors would not let her go: the infection in her legs was severe, but physicians found she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she walked out, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie controlled doses of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is commonly used in addiction recovery.

Five days later, on a day in November 2022, Stephanie gave birth to a daughter weighing a small weight – early, tiny yet healthy.

When the nurse asked if she wanted to embrace her child, Stephanie said “no.” She was detached. Her anesthesia was ineffective, her previous intake of fentanyl had been given four hours before delivery.

She felt sick. Unprepared to be a mother. Unworthy.

Stephanie had tried to get clean repeatedly before birth, and felt horrible each time she failed. She felt hopeless, berating herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her supplier refused to sell to her when she became clearly expecting.

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

The pervasive expectation that her affection for her child would make her recover only led to greater shame and self-harm, a cause for her to relapse. Yet she could not easily command her addiction away, any more than she could eliminate a persistent condition.

The newborn was transferred to the NICU. When Stephanie at last met her, she was connected to monitors, so small she thought she would break her. Cradling her initially, she felt detached. “I looked 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 the same as her nurse, after the nurse who had been so kind to her.

Nurses and doctors told her about a specialized facility, a unique recovery environment where mothers and their drug-exposed newborns are treated together, not apart.

In many parts of America, where a baby is identified with neonatal abstinence syndrome (NAS) regularly, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a developing system of centers like Maddie’s Place is showing an important truth: when parents and infants remain united, outcomes improve, custody cases decrease and long-term costs decline.

It took Stephanie a while to gather the courage to call, but she eventually made the call. After confirming she would be a good fit for the program, a couple of employees came to pick her up.

She departed the institution still in recovery, anxious and doubtful about what would come next.

At Maddie’s Place, Stephanie still was concerned that authorities would come seize her child – even though she was not sure she wanted to keep her. The concern persisted: that at any time, someone could arrive and separate them.

For the beginning period, Stephanie kept to herself. “I didn’t really want anything to do with any of them,” 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 one close friend, but even that connection was tenuous. The people she loved always found ways to cause pain. She was unable to care for herself, not to mention anyone else.

Daily, staff from the facility took her to a recovery program, provided orally. Over time, she was embracing sobriety.

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 adverse reactions to milk and obvious stomach troubles. She needed feeding therapy. She also had heightened sensory issues and required an professional – all typical problems for babies affected by withdrawal.

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

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for monitored interactions with their babies. A support specialist, a mentor, came over with her own family in tow to bring treats. They all gathered around Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in admiration of the little newborn in Stephanie’s arms. “They showed no judgment,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She holds a picture of the moment. She is wearing dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, sitting on the wooden floor with the entryway at her back. She is thin. Her posture is humble so you cannot see her face. She is lifting the baby on her knee for the children to see and they are crowding near, fawning and reaching out to the baby.

One child, eight, asked the mothers: “What about the fathers?” The moms tried to explain that the fathers had obligations, called away to other tasks, that they would be there given the chance.

“In the future,” Jacob said, “I will excel as a father. I will teach them about love.”

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.”

Tools for treating babies with exposure have existed for decades.

The evaluation method was developed in 1975|