🔗 Share this article She Was Pregnant and Addicted to Fentanyl: The Decision to Keep Her Child Saved Them Both. Eight months pregnant and in severe pain, a woman named Stephanie arrived at the ER after a serious infection started to spread up her legs. Without a job or home, estranged from her family, she lived in a shed she had constructed in a acquaintance's garden. She was also hooked on fentanyl. As physicians addressed her infection, she started to feel anxious. Withdrawal was setting in. She slumped forward and threw up. Stephanie ultimately gave in. “I need to leave. I have to go home and get high.” She had taken the drug before arriving at the hospital and had sufficient opportunity to get treated before she had to return to use once more. She thought she still had four weeks left to find a way to become sober and give birth. The attending nurse disagreed. She told Stephanie she was not allowed to leave. “I will go,” Stephanie said. But the doctors would not let her go: the infection in her legs was serious, but physicians found she also had an leakage of amniotic fluid. The nurse, her nurse, warned her: if she left, she and her baby would be at risk of death. The nurse convinced the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that abstinence might harm her and the baby. After delivery Stephanie would be transitioned to methadone, a medication that eases withdrawal and is commonly used in addiction recovery. After five days, on 12 November 2022, Stephanie had a daughter weighing just over four pounds – premature, little but surviving. When the attendant inquired if she wanted to embrace her child, Stephanie said “not now.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been administered shortly before she gave birth. She felt ill. Not ready for motherhood. Unworthy. Stephanie had attempted sobriety 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 “simply” stop using. Even her dealer would not provide to her when she became obviously with child. “However, I failed,” she said. “I required assistance.” The widespread belief that her affection for her child would make her recover only led to deeper self-loathing and self-harm, a cause for her to return to drugs. Yet she could not simply will her addiction away, any more than she could will away a long-term illness. The baby was taken to the NICU. When Stephanie at last met her, she was attached to medical equipment, so little she thought she would hurt her. Cradling her initially, she felt detached. “I just stared at her and was like, ‘What is our future?’” She still wasn’t sure she wanted to be her mother. Two days later she decided to call her daughter the same as her nurse, after the professional who provided support to her. Hospital staff told her about Maddie’s Place, a innovative treatment home where women and their babies are supported as a unit, not apart. In much of the US, where a baby is identified with infant withdrawal condition every 18 minutes, infants are still rushed to special care and given drugs while their mothers face child-protection investigations. But a small, growing network of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, foster placements fall and future expenses reduce. It took Stephanie some time to build confidence to call, but she eventually made the call. After verifying her eligibility for the program, two staff members came to pick her up. She stepped out of the hospital still in detox, fearful and unsure about what would happen next. At Maddie’s Place, Stephanie still worried that authorities would come remove her daughter – even though she was not sure she wanted to keep her. The anxiety remained: that at any moment, someone could walk in and take her baby away. For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.” Life on the streets, she said, was about survival. Drugs came first; faith came last. Stephanie had one close friend, but even that bond was fragile. The individuals she cared for always found ways to cause pain. She lacked the ability to love herself, not to mention anyone else. Each day, staff from Maddie’s Place transported her to a recovery program, provided orally. Over time, she was starting to get clean. She devoted all her time outside treatment 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 severe digestive problems. She needed feeding therapy. She also had heightened sensory issues and required an professional – all frequent conditions for babies born with NAS. Seeing that even a young person understands the need for care, then I was capable. I could be a mom. During a pre-holiday visit, Stephanie remained in the shared space, where parents in active addiction can come for guided meetings with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to deliver baked goods. They all assembled beside Stephanie, who was sitting on the floor holding Izzie. The young ones stared in wonder of the little newborn in Stephanie’s arms. “They were innocent,” 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 clad in casual attire, a gray knit hat with a pompom on her head, resting on the floor with the entryway at her back. She is lean. Her posture is humble so you miss her features. She is presenting her daughter on her lap for the children to see and they are gathered around, fawning and reaching out to the baby. Jacob, eight, asked the mothers: “Where are all the dads?” The women attempted to clarify that the men were occupied, handling responsibilities, that they would be there if possible. “Once I become a parent,” Jacob said, “I plan to be a great parent. They will know they are valued.” Stephanie and the specialist made eye contact. “I just lost it and fell apart,” Stephanie said. “Seeing that even youth understand that infants need affection, then I found the courage. I would become a mother.” Approaches for managing drug-exposed newborns have been available for years. The assessment tool was developed in 1975|