Fentanyl Addiction During Pregnancy: Choosing Motherhood Saved Them Both.

In her eighth month of pregnancy and suffering, a woman named Stephanie arrived at the medical facility after an infection began spreading up her legs. Unemployed and homeless, separated from loved ones, she lived in a shed she had built in a acquaintance's garden. She was also addicted to fentanyl.

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

Stephanie finally broke down. “Listen, I gotta go. I have to go home and take a hit.”

She had taken the drug before arriving at the hospital and had just enough time to get treated before she needed to go home to use once more. She thought she still had several weeks to plan her recovery and deliver her child.

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

“I will go,” Stephanie said.

But the hospital refused to discharge her: the infection in her legs was severe, but medical staff detected she also had an ruptured membrane. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in substance abuse treatment.

Five days later, on the 12th of November, Stephanie had a daughter weighing a small weight – born before term, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “I cannot.” She was numb. Her anesthesia was ineffective, her final administration of fentanyl had been provided shortly before she gave birth.

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

Stephanie had attempted sobriety several times during pregnancy, and felt terrible each time she failed. She felt without value, blaming herself for not being able to overcome the challenge. An doctor told her to “only” stop using. Even her supplier would not provide to her when she became clearly expecting.

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

The widespread belief that her love for her baby would make her quit only led to increased guilt and self-abuse, a cause for her to relapse. Yet she could not simply will her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was hooked up to monitors, so little she thought she would harm her. Embracing her at last, she felt detached. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

After two days she decided to call her daughter after her caregiver, after the attendant who showed compassion to her.

Medical personnel told her about a care center, a unique recovery environment where women and their babies are treated together, not apart.

In many parts of America, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still whisked to NICUs and given drugs while their mothers face custody evaluations. But a limited but expanding group of centers like the care home is demonstrating a key fact: when mothers and babies stay together, recovery succeeds, fewer children enter care and long-term costs decline.

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, care providers came to pick her up.

She stepped out of the hospital still in detox, anxious and doubtful about what would follow.

At the care center, Stephanie still feared that child services would come remove her daughter – even though she was hesitant about parenting. The fear lingered: that at any moment, someone could walk in and separate them.

For the first two weeks, Stephanie remained isolated. “I preferred to be alone,” she said. “I was suspicious at that point.”

Life on the streets, she said, was about getting by. Addiction came first; reliance came last.

Stephanie had a trusted ally, but even that bond was fragile. The those close to her always found ways to hurt her. She lacked the ability to care for herself, not to mention anyone else.

Each day, staff from Maddie’s Place drove her to a recovery program, provided orally. Slowly, she was beginning recovery.

She devoted all her time beyond therapy with Izzie, and could see that her baby was getting the specialized care she needed. Her infant faced feeding challenges at first, with intolerance to some formulas and severe digestive problems. She needed dietary support. She also had heightened sensory issues and required an professional – all frequent conditions for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I was capable. I could be a mom.

On a day prior to the holiday, Stephanie was in the common room, where those still using 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 seated on the ground holding Izzie.

The kids looked amazed in wonder of the little newborn in Stephanie’s arms. “They had no care in the world,” Stephanie said. “They overlooked my addiction. They focused only on the baby.”

She has an image of the moment. She is clad in black pants and a hoodie, a beanie with a pompom on her head, resting on the floor with the entryway at her back. She is thin. Her head is tilted forward so you miss her features. She is lifting the baby on her leg for the other kids to see and they are gathered around, fawning and reaching out to the baby.

One child, eight, asked the moms: “Why are there no men?” The parents responded that the men were occupied, handling responsibilities, that they would be there if they could.

“When I have kids,” Jacob said, “I will excel as a father. They will know they are valued.”

Stephanie and the specialist looked at each other. “I broke down,” Stephanie said. “When a child recognized that newborns require care, then I could do this. I could parent.”

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

The assessment tool was created in 1975|