She Was Pregnant and Addicted to Fentanyl: Choosing Motherhood Saved Them Both.

In her eighth month of pregnancy and suffering, the expectant mother arrived at the medical facility after her infection worsened up her legs. Without a job or home, separated from loved ones, she stayed in a makeshift shelter she had assembled in a acquaintance's garden. She was also hooked on fentanyl.

As medical staff managed her infection, she started to feel anxious. Withdrawal was setting in. She bent over the bedside and became sick.

Stephanie finally broke down. “I have to get out of here. I have to go home and take a hit.”

She had consumed opioids before arriving at the hospital and had just enough time to get treated before she was compelled to leave to get high again. She thought she still had a month remaining to plan her recovery and give birth.

The attending nurse disagreed. She told Stephanie she was not going anywhere.

“I am leaving,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she left, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie measured quantities of fentanyl every few hours, knowing that withdrawal could endanger her and the baby. After delivery Stephanie would be switched to methadone, a drug that alleviates cravings and is commonly used in rehabilitation.

Five days later, on the 12th of November, Stephanie had a infant weighing 4lb 8oz – early, small but alive.

When the nurse asked if she wanted to cuddle her newborn, Stephanie said “not now.” She was numb. Her pain relief did not work, her last dose of fentanyl had been administered four hours before delivery.

She felt sick. Ill-equipped for parenting. Not fit.

Stephanie had attempted sobriety several times during pregnancy, and felt awful each time she failed. She felt worthless, berating herself for not being able to overcome the challenge. An doctor 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 had to seek support.”

The pervasive expectation that her love for her baby would make her quit only led to deeper self-loathing and self-harm, a trigger for her to relapse. Yet she could not just wish her addiction away, any more than she could eliminate a chronic disease.

The infant was moved to the special care nursery. When Stephanie finally saw her her, she was attached to medical equipment, so small she thought she would break 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 name her baby the same as her nurse, after the nurse who had been so kind to her.

Nurses and doctors told her about Maddie’s Place, a new kind of care center where women and their babies are supported as a unit, not apart.

In numerous states, where a baby is diagnosed with infant withdrawal condition frequently, infants are still whisked to NICUs and treated with pharmaceuticals while their mothers face parental assessments. But a developing system of centers like Maddie’s Place is demonstrating a key fact: when mothers and babies stay together, outcomes improve, foster placements fall and overall savings increase.

It took Stephanie some time to build confidence to call, but she eventually made the call. After confirming she would be a good fit for the program, care providers came to pick her up.

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

At the facility, Stephanie still feared that CPS would come remove her daughter – even though she was hesitant about parenting. The anxiety remained: that at any moment, someone could walk in and separate them.

For the beginning period, Stephanie remained isolated. “I avoided interaction,” she said. “I was suspicious at that point.”

Survival outdoors, she said, was about enduring. Addiction came first; trust came last.

Stephanie had a single companion, but even that connection was tenuous. The people she loved always found ways to let her down. She lacked the ability to love herself, let alone anyone else.

Each day, staff from Maddie’s Place transported her to a clinic for methadone, given as medication. Over time, she was starting to get clean.

She spent every minute 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 dietary support. 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 could do this. I could parent.

During a pre-holiday visit, Stephanie was in the common room, where those still using can come for supervised visits with their babies. Katie Bunch-Smith, a recovery coach, came over with her own five kids in tow to drop off cookies. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in admiration 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. They focused only on the baby.”

She keeps a photo of the moment. She is wearing black pants and a hoodie, a gray knit hat with a bobble on her head, resting on the floor with the door behind her. She is slender. Her head is tilted forward so you miss her features. She is holding Izzie up on her leg for the other kids to see and they are gathered around, admiring and touching to the baby.

One child, eight, asked the parents: “What about the fathers?” The parents responded that the dads were busy, engaged elsewhere, 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 Bunch-Smith exchanged glances. “I just lost it and fell apart,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I would become a mother.”

Tools for treating babies with exposure have existed for decades.

The assessment tool was created in 1975|