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

In her eighth month of pregnancy and suffering, a woman named Stephanie went to the ER after an infection began spreading up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had built in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and vomited.

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

She had taken the drug before seeking medical help and had only a brief window to get treated before she had to return to get high again. She thought she still had a month remaining to figure out how to get clean and deliver her child.

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

“Yes, I am,” Stephanie said.

But the medical facility declined to release her: the condition in her limbs was serious, but doctors had discovered she also had an leakage of amniotic fluid. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. Once the baby was born Stephanie would be switched to methadone, a treatment that reduces symptoms and is commonly used in addiction recovery.

A short time later, on the 12th of November, Stephanie had a baby girl weighing a small weight – premature, little but surviving.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was detached. Her pain relief did not work, her previous intake of fentanyl had been administered shortly before she gave birth.

She felt unwell. Ill-equipped for parenting. Unworthy.

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she was unsuccessful. She felt without value, criticizing herself for not being able to achieve the unattainable. An OBGYN told her to “only” stop using. Even her dealer declined to supply to her when she became clearly expecting.

“But I couldn’t,” she said. “I required assistance.”

The widespread belief that her bond with her newborn would make her quit only led to increased guilt and self-abuse, a trigger for her to use again. Yet she could not easily command her addiction away, any more than she could overcome a long-term illness.

The baby was taken to the neonatal intensive care unit. When Stephanie at last met her, she was connected to monitors, so little she thought she would hurt her. Holding her for the first time, she felt empty. “I looked at her and was like, ‘How will I care for you?’” She still wasn’t sure she wanted to be her mother.

After two days she decided to give her child the name Izzie, after the professional who provided support to her.

Nurses and doctors told her about Maddie’s Place, a unique recovery environment where women and their babies are cared for jointly, not apart.

In many parts of America, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still quickly moved to hospitals and treated with pharmaceuticals while their mothers face child-protection investigations. But a limited but expanding group of centers like the care home is showing an important truth: when parents and infants remain united, outcomes improve, custody cases decrease and overall savings increase.

It took Stephanie a period to find strength 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 stepped out of the hospital still in detox, fearful and unsure about what would come next.

At the care center, Stephanie still worried that child services would come seize her child – even though she was not sure she wanted to keep her. The fear lingered: that at any point, someone could walk in and remove her child.

For the initial fortnight, Stephanie remained isolated. “I didn’t really want anything to do with any of them,” she said. “I lacked confidence at that point.”

Homelessness, she said, was about survival. Addiction came first; trust came last.

Stephanie had a trusted ally, but even that relationship was delicate. The people she loved always found ways to cause pain. She lacked the ability to care for herself, much less anyone else.

Every day, staff from the center transported her to a treatment center, provided orally. Slowly, she was starting to get clean.

She devoted all her time when not in sessions with Izzie, and could see that her baby was receiving appropriate attention she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and obvious stomach troubles. She needed nutritional guidance. She also had sensory challenges and required an specialist – all frequent conditions for babies born with NAS.

When a child recognizes these infants need affection, then I found the strength. I would become a mother.

On a day prior to the holiday, Stephanie was in the common room, where individuals struggling with substance use can come for supervised visits with their babies. A support specialist, a peer support specialist, 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 children were wide-eyed in admiration 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. They focused only on the baby.”

She keeps a photo of the moment. She is clad in casual attire, a cap with a decoration on her head, seated on the ground with the exit nearby. She is thin. Her face is downcast so you do not see her expression. She is lifting the baby on her lap for the other kids to see and they are crowding near, fawning and reaching out to the baby.

A young boy, eight, asked the mothers: “What about the fathers?” The women attempted to clarify that the dads were busy, handling responsibilities, that they would be there given the chance.

“In the future,” Jacob said, “I plan to be a great parent. They will know they are valued.”

Stephanie and her companion made eye contact. “I became emotional,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I would become a mother.”

Methods to address babies with exposure have been available for years.

The Finnegan NAS scale was developed in 1975|