A Pregnant Woman's Battle with Fentanyl Addiction: The Decision to Keep Her Child Saved Them Both.

In her eighth month of pregnancy and suffering, the expectant mother went to the hospital emergency room 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 assembled in a companion's property. She was also addicted to fentanyl.

As physicians addressed her infection, she began to panic. The onset of withdrawal began. She bent over the bedside and became sick.

Stephanie finally broke down. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before arriving at the hospital and had only a brief window to get treated before she was compelled to leave to use once more. She thought she still had several weeks to plan her recovery and give birth.

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

“I am leaving,” Stephanie said.

But the medical facility declined to release her: the infection in her legs was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, Izzie, warned her: if she walked out, she and her baby would face grave danger.

She encouraged the doctor to give Stephanie controlled doses of fentanyl periodically, knowing that withdrawal could endanger her and the baby. Post-birth Stephanie would be switched to methadone, a drug that alleviates cravings and is often prescribed in rehabilitation.

After five days, on a day in November 2022, Stephanie gave birth to a infant weighing just over four pounds – early, little but surviving.

When the nurse asked if she wanted to hold her baby, Stephanie said “I cannot.” She was emotionless. Her epidural had failed, her previous intake of fentanyl had been provided a few hours prior to birth.

She felt unwell. Not ready for motherhood. Undeserving.

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she failed. She felt worthless, criticizing herself for not being able to do the impossible. An OBGYN told her to “just” stop using. Even her supplier declined to supply to her when she became clearly expecting.

“However, I failed,” she said. “I had to seek support.”

The pervasive expectation that her love for her baby would make her stop using only led to deeper self-loathing and self-harm, a trigger 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 infant was moved to the special care nursery. When Stephanie eventually visited her, she was hooked up to monitors, so little she thought she would break her. Embracing her at last, she felt empty. “I gazed upon her and was like, ‘What am I going to do with you?’” She remained uncertain she wanted to be her mother.

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

Hospital staff 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 many parts of America, where a baby is diagnosed with infant withdrawal condition every 18 minutes, infants are still rushed to special care and medicated while their mothers face child-protection investigations. But a limited but expanding group of centers like this facility is proving a simple point: when mothers and babies stay together, 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 ensuring she qualified for the program, a couple of employees came to collect her.

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

At the facility, Stephanie still feared 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 separate them.

For the beginning period, Stephanie remained isolated. “I preferred to be alone,” she said. “I didn’t have a lot of trust at that point.”

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

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

Every day, staff from the center drove her to a treatment center, provided orally. Gradually, she was starting to get clean.

She spent every minute beyond therapy with Izzie, and could see that her baby was receiving appropriate attention she needed. Her girl had some trouble feeding at first, with adverse reactions to milk and pronounced gastrointestinal issues. She needed dietary support. She also had heightened sensory issues and required an professional – all typical problems for babies affected by withdrawal.

Seeing that even a young person understands the need for care, then I found the strength. I would become a mother.

During a pre-holiday visit, Stephanie sat in the visitation area, where individuals struggling with substance use can come for monitored interactions with their babies. Katie Bunch-Smith, a mentor, stopped by with her own family in tow to bring treats. They all gathered around Stephanie, who was sitting on the floor holding Izzie.

The young ones stared in wonder of the tiny infant in Stephanie’s arms. “They had no care in the world,” Stephanie said. “My past did not matter to them. None of those things mattered to them.”

She holds a picture of the moment. She is clad in black pants and a hoodie, a beanie with a bobble on her head, seated on the ground with the door behind her. She is lean. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her lap for the children to see and they are crowding near, admiring and touching to the baby.

One child, eight, asked the parents: “Where are all the dads?” The women attempted to clarify 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 her companion made eye contact. “I just lost it and fell apart,” Stephanie said. “If this little kid could see that infants need affection, then I was able. I could parent.”

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

The Finnegan NAS scale was created in 1975|