A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Transformed Their Futures.

Pregnant and experiencing intense discomfort, the expectant mother visited the ER after a serious infection started to spread up her legs. Without a job or home, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a friend’s yard. She was also hooked on fentanyl.

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

Stephanie eventually collapsed. “I have to get out of here. I have to go home and get high.”

She had consumed opioids before arriving at the hospital and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had four weeks left to find a way to become sober and deliver her child.

The attending nurse disagreed. She told Stephanie she was staying put.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but medical staff detected she also had an ruptured membrane. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death.

She encouraged the doctor to give Stephanie measured quantities of fentanyl at regular intervals, knowing that abstinence might harm her and the baby. Post-birth Stephanie would be placed on methadone, a treatment that reduces symptoms and is commonly used in rehabilitation.

After five days, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, tiny yet healthy.

When the attendant inquired if she wanted to hold her baby, Stephanie said “no.” She was emotionless. Her pain relief did not work, her last dose of fentanyl had been provided a few hours prior to birth.

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

Stephanie had tried to get clean repeatedly before birth, and felt terrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to do the impossible. An obstetrician told her to “simply” 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 affection for her child would make her recover only led to increased guilt 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 special care nursery. When Stephanie at last met her, she was hooked up to medical equipment, so tiny she thought she would break her. Cradling her initially, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She still wasn’t sure she wanted to be her mother.

Following a brief period she decided to call her daughter after her caregiver, after the nurse who had been so kind to her.

Medical personnel told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are treated together, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition regularly, infants are still whisked to NICUs and medicated while their mothers face custody evaluations. But a developing system of centers like the care home is proving a simple point: when families are kept intact, results get better, fewer children enter care and overall savings increase.

It took Stephanie a period to find strength to call, but she finally did. After confirming she would be a good fit for the program, two staff members came to pick her up.

She left the medical center still in withdrawal, fearful and unsure about what would come next.

At the facility, Stephanie still feared that child services would come take Izzie – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could enter and separate them.

For the initial fortnight, Stephanie stayed withdrawn. “I preferred to be alone,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about getting by. Substances came first; faith came last.

Stephanie had one close friend, but even that connection was tenuous. The those close to her always found ways to hurt her. She did not know how to love herself, not to mention anyone else.

Daily, staff from Maddie’s Place transported her to a treatment center, administered in pill form. Gradually, she was beginning recovery.

She utilized each moment when not in sessions with Izzie, and could see that her baby was obtaining necessary support she needed. Her girl had some trouble feeding at first, with intolerance to some formulas and pronounced gastrointestinal issues. She needed dietary support. She also had sensory challenges and required an specialist – all typical problems for babies exposed to substances.

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

During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. An advocate, a recovery coach, stopped by with her own five kids in tow to bring treats. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The young ones stared in awe of the small baby in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. Such issues were irrelevant.”

She has an image of the moment. She is clad in dark trousers and a sweatshirt, a gray knit hat 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 miss her features. She is lifting the baby on her leg for the other kids to see and they are standing close, showing interest to the baby.

Jacob, eight, asked the mothers: “What about the fathers?” The parents responded that the dads were busy, engaged elsewhere, that they would be there if possible.

“In the future,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and the specialist exchanged glances. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”

Approaches for managing babies with exposure have been used for a long time.

The Finnegan NAS scale was established in 1975|