Fentanyl Addiction During Pregnancy: How Keeping Her Baby 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. Without a job or home, estranged from her family, she lived in a shed she had assembled in a friend’s yard. She was also hooked on fentanyl.

As medical staff managed her infection, she grew increasingly fearful. Withdrawal was setting in. She leaned over the bed and vomited.

Stephanie ultimately gave in. “I have to get out of here. I have to go home and take a hit.”

She had used fentanyl before coming to the ER and had sufficient opportunity to get treated before she was compelled to leave to use once more. She thought she still had four weeks left to plan her recovery and have this baby.

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

“Yes, I am,” Stephanie said.

But the doctors would not let her go: the condition in her limbs was critical, but doctors had discovered she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she departed, she and her baby would face grave danger.

Izzie persuaded the doctor to give Stephanie measured quantities of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Once the baby was born Stephanie would be switched to methadone, a medication that eases withdrawal and is frequently utilized in rehabilitation.

Five days later, on a day in November 2022, Stephanie delivered a baby girl weighing 4lb 8oz – early, tiny yet healthy.

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

She felt ill. Not ready for motherhood. Unworthy.

Stephanie had tried to get clean multiple times while expecting, and felt horrible each time she was unsuccessful. She felt hopeless, berating herself for not being able to do the impossible. An OBGYN told her to “simply” stop using. Even her source declined to supply to her when she became visibly pregnant.

“But I couldn’t,” she said. “I had to seek support.”

The pervasive expectation that her bond with her newborn would make her stop using only led to deeper self-loathing and negative self-talk, a impetus for her to use again. Yet she could not easily command her addiction away, any more than she could eliminate a chronic disease.

The newborn was transferred to the neonatal intensive care unit. When Stephanie finally saw her her, she was connected to medical equipment, 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 still wasn’t sure she wanted to be her mother.

Two days later she decided to call her daughter Izzie, after the nurse who had been so kind to her.

Nurses and doctors told her about a specialized facility, a new kind of care center where mothers and their drug-exposed newborns are treated together, not apart.

In numerous states, where a baby is diagnosed with newborn addiction symptoms every 18 minutes, infants are still whisked to NICUs and medicated while their mothers face parental assessments. But a limited but expanding group of centers like this facility is proving a simple point: when parents and infants remain united, recovery succeeds, custody cases decrease and future expenses reduce.

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, two staff members came to collect her.

She left the medical center still in detox, scared and uncertain about what would follow.

At the care center, Stephanie still worried that child services would come take Izzie – even though she was uncertain about motherhood. The fear lingered: that at any point, someone could arrive and remove her child.

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

Life on the streets, she said, was about enduring. Addiction came first; faith came last.

Stephanie had a single companion, but even that relationship was delicate. The people she loved always found ways to hurt her. She was unable to care for herself, not to mention anyone else.

Each day, staff from Maddie’s Place took her to a treatment center, administered in pill form. Over time, she was starting to get clean.

She spent every minute beyond therapy with Izzie, and could see that her baby was obtaining necessary support she needed. Her daughter struggled with eating at first, with sensitivity to certain foods and pronounced gastrointestinal issues. She needed nutritional guidance. She also had sensory challenges and required an occupational therapist – all typical problems for babies affected by withdrawal.

If this little kid could see that these babies deserve to be loved, then I was capable. I could parent.

On a day prior to the holiday, Stephanie remained in the shared space, where parents in active addiction can come for monitored interactions with their babies. A support specialist, a recovery coach, stopped by with her own five kids in tow to bring treats. They all crowded near Stephanie, who was resting on the carpet holding Izzie.

The children were wide-eyed in awe of the little newborn in Stephanie’s arms. “They had no care in the world,” 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 dark trousers and a sweatshirt, a gray knit hat with a bobble on her head, seated on the ground with the entryway at her back. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her knee for the children to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the moms: “What about the fathers?” The parents responded 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 became emotional,” Stephanie said. “Seeing that even youth understand that these babies deserve to be loved, then I found the courage. I would become a mother.”

Approaches for managing babies with exposure have been available for years.

The assessment tool was created in 1975|